Hmo / Ppo ? - ThinnerTimes

Rachel- · 10-27-2005, 01:59 AM

What the heck is the difference?
What's an HMO?
What's a PPO?

haha! I've never had insurance before... (wow that sounds odd.)

D's Hope · 10-27-2005, 02:11 AM

An HMO is where you have an assigned doctor that you have to see prior to seeing any other doctor, the HMO doctor has to give you a referral and are members of and IPA, who are all paid by the particular IPA. HMO is usually cheaper as you only need to pay your co payment.

A PPO is where you can go to any doctor you choose without needing a referral. Usually the co payment is higher and you are responsible for like 20% of all costs.

I have an insurance where I have both options as well as a third tier that is out of network. The only way I could get this surgery done was through my HMO, my insurance would not have paid for it in my PPO or Out Of Network options, which I thought was strange. But basically, I just paid my $250 copay for the hospital admission, the rest was covered.

I hope that helps some.

Hope

Rachel- · 10-27-2005, 02:14 AM

Quote:

Originally Posted by D's Hope

An HMO is where you have an assigned doctor that you have to see prior to seeing any other doctor, the HMO doctor has to give you a referral and are members of and IPA, who are all paid by the particular IPA. HMO is usually cheaper as you only need to pay your co payment.

A PPO is where you can go to any doctor you choose without needing a referral. Usually the co payment is higher and you are responsible for like 20% of all costs.

I have an insurance where I have both options as well as a third tier that is out of network. The only way I could get this surgery done was through my HMO, my insurance would not have paid for it in my PPO or Out Of Network options, which I thought was strange. But basically, I just paid my $250 copay for the hospital admission, the rest was covered.

I hope that helps some.

Hope

That helps a lot!
Thank God I chose the HMO! haha!

Jtcox88 · 10-27-2005, 08:02 AM

I Kick myself for not having the surgery while I was at my old job. I had a PPO then. It was awesome!!! I chose (instead of a medical group) who, when, where, why & what doctor I wanted to see. I didn't have to take the 6 months of nutrition classes or any of the other BS. My insurance was also free through my work (this is not normal). Too bad I didn't understand just how good it was until it was gone.

Now I have an HMO & I have way to many hoops to jump through. All of my problems are from the medical group instead of my HMO. My doctor wanted me to wait until I got on a PPO plan before I started all the pre-op tests. Unfortunately, my new job doesn't offer PPO only HMO. If I had the option, even with paying a higher premium I absolutely would have chosen the PPO.

I guess it just depends on what each of your medical plans will cover. Take a close look at the benefits of each plan vs. the cost. Then make your decision.

Good Luck!

Doc J · 10-27-2005, 08:29 AM

I had the exact opposite experience as Terrah. I have an HMO and it was a breeze. No 6 month medically supervised diet. I think it might have helped that I have been with this Dr. and this group for over 15 years. When I asked my PCP about the surgery, he said he thought I would be a good candidate and started the ball rolling.
I think every Insurance plan and every Insurance company is different. All you can do is to investigate thoroughly before deciding on which one to choose.

D's Hope · 10-27-2005, 08:32 AM

The first medical group I was with would not approve it. I filed greivance after greivance and still no luck. I called the surgeon and asked him if he is contracted with any HMO's and what medical group, they told me and I called and switched medical groups. My switch was effective September 7th and I had my surgery October 17th.

So try that, switching your IPA, I was amazed at the difference in care I got.

Hope