Re: HMO vs PPO

[Guest guest]

HMOs cover the basic stuff like childbirth and tubeals but weird stuff like NF, there is Was a problems. At least for me. -Lori:)

DOINK , DOINK!!! Add this

Re: HMO vs PPO

What doesn't it pay for Rhonda? Anything important? Carol becvar wrote:

Crew- Help! Our company is going through open enrollment for group health insurance. Before NF2 I always went with the PPO for freedom to choose which doctor we saw. However, since has had two surgeries this year and will have another in January as well as radiation for 5 weeks, I am having a hard time deciding which plan to choose. The HMO pays almost everything with no deductible!! All of our doctors are on both the HMO and the PPO (no help there!). I am not sure how well all the PCP/Referrals, etc. would work for us. It sure would save a lot of money, though. Now I know how those Floridians must feel!! Decisions...decisions...decisions!! Any advice??? I have to turn in my decision by this Friday and my husband says, "you decide". A lot of help he is!! Rhonda

[Guest guest]

PPO is a good move for an NF2er. I worked for 8 yrs in Human Resources /

Benefits, and stick with PPOs myself. The main difference is an HMO will

fight you hard if you need to see a doctor outside their network.

Bradford was told he couldn't go to HEI's clinic to see their surgeons or get

the ABI. They told him to go to Utah. His mom called the doc who stated he

had never taken an AN out before, but hey, he was willing to try.

PPOs typically pay 80% of your annual bills until you hit a ceiling, maybe

$2000 out of your pocket, then they jump to 100% - provided you see one of

the doctors in their network. If you see somebody else, they pay 60% and

raise the annual out of pocket to maybe $4500. But as I have done in the

past, you can have your doc out of the network write the ins company stating

NF2 is very rare and you need to see someone familiar with it. The last

company I went thru said ok and paid the full 80%. I changed jobs 4 months

ago and havent done it again yet.

Another BIG difference is that HMOs will claim " pre-existing condition "

exclusion for any charges related to illness that was diagnosed before you

sign up with them. PPOs rarely have pre-existing condition clauses. Bill

Clinton tried to have pre-existing clauses outlawed but I don't think he was

successful.

Anybody who has an HMO and is happy with it, great. You are the exception to

the rule. In general HMOs are best suited for generally healthy people who

don't see docs often at all.

[Guest guest]

PPO is a good move for an NF2er. I worked for 8 yrs in Human Resources /

Benefits, and stick with PPOs myself. The main difference is an HMO will

fight you hard if you need to see a doctor outside their network.

Bradford was told he couldn't go to HEI's clinic to see their surgeons or get

the ABI. They told him to go to Utah. His mom called the doc who stated he

had never taken an AN out before, but hey, he was willing to try.

PPOs typically pay 80% of your annual bills until you hit a ceiling, maybe

$2000 out of your pocket, then they jump to 100% - provided you see one of

the doctors in their network. If you see somebody else, they pay 60% and

raise the annual out of pocket to maybe $4500. But as I have done in the

past, you can have your doc out of the network write the ins company stating

NF2 is very rare and you need to see someone familiar with it. The last

company I went thru said ok and paid the full 80%. I changed jobs 4 months

ago and havent done it again yet.

Another BIG difference is that HMOs will claim " pre-existing condition "

exclusion for any charges related to illness that was diagnosed before you

sign up with them. PPOs rarely have pre-existing condition clauses. Bill

Clinton tried to have pre-existing clauses outlawed but I don't think he was

successful.

Anybody who has an HMO and is happy with it, great. You are the exception to

the rule. In general HMOs are best suited for generally healthy people who

don't see docs often at all.