HMO or PPO

[AnD]

I agree with Skye- you need to find out the details of each actual plan that your husband is being offered- I have had PPO's that had no lifetime limit or million limit, that had 20% copays or $15 copays, covered specialty prescription drugs like Pulmozyme/didn't cover them, etc. The plan I have now has a big inpatient copay, but pays 100% of home Ivs...

I'd get together a list of what you need (drugs you're on, drugs you could be on- to make sure they are even covered, hospital copay info, prescription copays, doctor copays, make sure your cf clinic and other current dr.s are "in network", etc.) and take it to the HR person at the new job, and ask for some help, or at least the latest benefits book on each one. Good luck!

 

[AnD]

I agree with Skye- you need to find out the details of each actual plan that your husband is being offered- I have had PPO's that had no lifetime limit or million limit, that had 20% copays or $15 copays, covered specialty prescription drugs like Pulmozyme/didn't cover them, etc. The plan I have now has a big inpatient copay, but pays 100% of home Ivs...

I'd get together a list of what you need (drugs you're on, drugs you could be on- to make sure they are even covered, hospital copay info, prescription copays, doctor copays, make sure your cf clinic and other current dr.s are "in network", etc.) and take it to the HR person at the new job, and ask for some help, or at least the latest benefits book on each one. Good luck!

 

[AnD]

I agree with Skye- you need to find out the details of each actual plan that your husband is being offered- I have had PPO's that had no lifetime limit or million limit, that had 20% copays or $15 copays, covered specialty prescription drugs like Pulmozyme/didn't cover them, etc. The plan I have now has a big inpatient copay, but pays 100% of home Ivs...

I'd get together a list of what you need (drugs you're on, drugs you could be on- to make sure they are even covered, hospital copay info, prescription copays, doctor copays, make sure your cf clinic and other current dr.s are "in network", etc.) and take it to the HR person at the new job, and ask for some help, or at least the latest benefits book on each one. Good luck!

 

[AnD]

I agree with Skye- you need to find out the details of each actual plan that your husband is being offered- I have had PPO's that had no lifetime limit or million limit, that had 20% copays or $15 copays, covered specialty prescription drugs like Pulmozyme/didn't cover them, etc. The plan I have now has a big inpatient copay, but pays 100% of home Ivs...

I'd get together a list of what you need (drugs you're on, drugs you could be on- to make sure they are even covered, hospital copay info, prescription copays, doctor copays, make sure your cf clinic and other current dr.s are "in network", etc.) and take it to the HR person at the new job, and ask for some help, or at least the latest benefits book on each one. Good luck!

 

[AnD]

I agree with Skye- you need to find out the details of each actual plan that your husband is being offered- I have had PPO's that had no lifetime limit or million limit, that had 20% copays or $15 copays, covered specialty prescription drugs like Pulmozyme/didn't cover them, etc. The plan I have now has a big inpatient copay, but pays 100% of home Ivs...
<br />
<br />I'd get together a list of what you need (drugs you're on, drugs you could be on- to make sure they are even covered, hospital copay info, prescription copays, doctor copays, make sure your cf clinic and other current dr.s are "in network", etc.) and take it to the HR person at the new job, and ask for some help, or at least the latest benefits book on each one. Good luck!

 

[paysmom]

Last year we had a PPO and we paid out of pocket $6000 just on two hospital stays not including the $30 co pays for doc appt and meds. Now we have an HMO and we only pay $10 for doc appt and meds including polmozyme the only diff is that you have to have a pa before your polmozyme and HTS is filled and that can take a few days. We also pay nothing if he is admitted in to the hospital. Just make sure that everyone you go to is covered.

 

[paysmom]

Last year we had a PPO and we paid out of pocket $6000 just on two hospital stays not including the $30 co pays for doc appt and meds. Now we have an HMO and we only pay $10 for doc appt and meds including polmozyme the only diff is that you have to have a pa before your polmozyme and HTS is filled and that can take a few days. We also pay nothing if he is admitted in to the hospital. Just make sure that everyone you go to is covered.

 

[paysmom]

Last year we had a PPO and we paid out of pocket $6000 just on two hospital stays not including the $30 co pays for doc appt and meds. Now we have an HMO and we only pay $10 for doc appt and meds including polmozyme the only diff is that you have to have a pa before your polmozyme and HTS is filled and that can take a few days. We also pay nothing if he is admitted in to the hospital. Just make sure that everyone you go to is covered.

 

[paysmom]

Last year we had a PPO and we paid out of pocket $6000 just on two hospital stays not including the $30 co pays for doc appt and meds. Now we have an HMO and we only pay $10 for doc appt and meds including polmozyme the only diff is that you have to have a pa before your polmozyme and HTS is filled and that can take a few days. We also pay nothing if he is admitted in to the hospital. Just make sure that everyone you go to is covered.

 

[paysmom]

Last year we had a PPO and we paid out of pocket $6000 just on two hospital stays not including the $30 co pays for doc appt and meds. Now we have an HMO and we only pay $10 for doc appt and meds including polmozyme the only diff is that you have to have a pa before your polmozyme and HTS is filled and that can take a few days. We also pay nothing if he is admitted in to the hospital. Just make sure that everyone you go to is covered.

 

[2005CFmom]

Like everyone said, you need the details on the two plans. If the PPO has the coverage you need and is affordable, that would be my choice (even if it is more expensive than the HMO).

HMO's can be a real pain in the a$$ to deal with. Not only do you need to make sure that the providers you want take your HMO, you need to know what specialist your primary provider works with.

For example, say you want to go to Clinic A for your CF care. You need to make sure that Clinic A is part of your primary care physicians GROUP. Even if Clinic A is part of the HMO insurance network, your PCP group will first send you to what clinic is part of there group, that might be Clinic B. And getting your Group to refer outside their "network" will be a fight. And if there is no CF clinic in their network, they will probably want to send you to the Pulmo specialist (who may or may not refer you to a CF clinic).

I know not all HMO's work on the "Group" level, but if the one your offered does, just know that you may end up fighting with both the insurance Group and the Insurance company!

Granted, the HMO stuff is worst case scenario and you might not find yourself with these problems. You could find a PCP that refers to your CF doctors that are all in network and have no problems at all.

Bottomline, do your homework so you know what kind of plans you are dealing with.


I hope I made sense, it is all very confusing. If you need clarification please let me know!

 

[2005CFmom]

Like everyone said, you need the details on the two plans. If the PPO has the coverage you need and is affordable, that would be my choice (even if it is more expensive than the HMO).

HMO's can be a real pain in the a$$ to deal with. Not only do you need to make sure that the providers you want take your HMO, you need to know what specialist your primary provider works with.

For example, say you want to go to Clinic A for your CF care. You need to make sure that Clinic A is part of your primary care physicians GROUP. Even if Clinic A is part of the HMO insurance network, your PCP group will first send you to what clinic is part of there group, that might be Clinic B. And getting your Group to refer outside their "network" will be a fight. And if there is no CF clinic in their network, they will probably want to send you to the Pulmo specialist (who may or may not refer you to a CF clinic).

I know not all HMO's work on the "Group" level, but if the one your offered does, just know that you may end up fighting with both the insurance Group and the Insurance company!

Granted, the HMO stuff is worst case scenario and you might not find yourself with these problems. You could find a PCP that refers to your CF doctors that are all in network and have no problems at all.

Bottomline, do your homework so you know what kind of plans you are dealing with.


I hope I made sense, it is all very confusing. If you need clarification please let me know!

 

[2005CFmom]

Like everyone said, you need the details on the two plans. If the PPO has the coverage you need and is affordable, that would be my choice (even if it is more expensive than the HMO).

HMO's can be a real pain in the a$$ to deal with. Not only do you need to make sure that the providers you want take your HMO, you need to know what specialist your primary provider works with.

For example, say you want to go to Clinic A for your CF care. You need to make sure that Clinic A is part of your primary care physicians GROUP. Even if Clinic A is part of the HMO insurance network, your PCP group will first send you to what clinic is part of there group, that might be Clinic B. And getting your Group to refer outside their "network" will be a fight. And if there is no CF clinic in their network, they will probably want to send you to the Pulmo specialist (who may or may not refer you to a CF clinic).

I know not all HMO's work on the "Group" level, but if the one your offered does, just know that you may end up fighting with both the insurance Group and the Insurance company!

Granted, the HMO stuff is worst case scenario and you might not find yourself with these problems. You could find a PCP that refers to your CF doctors that are all in network and have no problems at all.

Bottomline, do your homework so you know what kind of plans you are dealing with.


I hope I made sense, it is all very confusing. If you need clarification please let me know!

 

[2005CFmom]

Like everyone said, you need the details on the two plans. If the PPO has the coverage you need and is affordable, that would be my choice (even if it is more expensive than the HMO).

HMO's can be a real pain in the a$$ to deal with. Not only do you need to make sure that the providers you want take your HMO, you need to know what specialist your primary provider works with.

For example, say you want to go to Clinic A for your CF care. You need to make sure that Clinic A is part of your primary care physicians GROUP. Even if Clinic A is part of the HMO insurance network, your PCP group will first send you to what clinic is part of there group, that might be Clinic B. And getting your Group to refer outside their "network" will be a fight. And if there is no CF clinic in their network, they will probably want to send you to the Pulmo specialist (who may or may not refer you to a CF clinic).

I know not all HMO's work on the "Group" level, but if the one your offered does, just know that you may end up fighting with both the insurance Group and the Insurance company!

Granted, the HMO stuff is worst case scenario and you might not find yourself with these problems. You could find a PCP that refers to your CF doctors that are all in network and have no problems at all.

Bottomline, do your homework so you know what kind of plans you are dealing with.


I hope I made sense, it is all very confusing. If you need clarification please let me know!

 

[2005CFmom]

Like everyone said, you need the details on the two plans. If the PPO has the coverage you need and is affordable, that would be my choice (even if it is more expensive than the HMO).
<br />
<br />HMO's can be a real pain in the a$$ to deal with. Not only do you need to make sure that the providers you want take your HMO, you need to know what specialist your primary provider works with.
<br />
<br />For example, say you want to go to Clinic A for your CF care. You need to make sure that Clinic A is part of your primary care physicians GROUP. Even if Clinic A is part of the HMO insurance network, your PCP group will first send you to what clinic is part of there group, that might be Clinic B. And getting your Group to refer outside their "network" will be a fight. And if there is no CF clinic in their network, they will probably want to send you to the Pulmo specialist (who may or may not refer you to a CF clinic).
<br />
<br />I know not all HMO's work on the "Group" level, but if the one your offered does, just know that you may end up fighting with both the insurance Group and the Insurance company!
<br />
<br />Granted, the HMO stuff is worst case scenario and you might not find yourself with these problems. You could find a PCP that refers to your CF doctors that are all in network and have no problems at all.
<br />
<br />Bottomline, do your homework so you know what kind of plans you are dealing with.
<br />
<br />
<br />I hope I made sense, it is all very confusing. If you need clarification please let me know!

 

[Tumbleweed]

Thanks guys-

Yeah, I don't have the details of either plan yet, I'll be sure to investigate when I do get them. It would be nice to not have to jump through HMO hoops if I <i>knew for a fact</i> that medicare was for sure covering the rest. (Currently Medicare is paying for everything for me... so it's a better change either way!)

 

[Tumbleweed]

Thanks guys-

Yeah, I don't have the details of either plan yet, I'll be sure to investigate when I do get them. It would be nice to not have to jump through HMO hoops if I <i>knew for a fact</i> that medicare was for sure covering the rest. (Currently Medicare is paying for everything for me... so it's a better change either way!)

 

[Tumbleweed]

Thanks guys-

Yeah, I don't have the details of either plan yet, I'll be sure to investigate when I do get them. It would be nice to not have to jump through HMO hoops if I <i>knew for a fact</i> that medicare was for sure covering the rest. (Currently Medicare is paying for everything for me... so it's a better change either way!)

 

[Tumbleweed]

Thanks guys-

Yeah, I don't have the details of either plan yet, I'll be sure to investigate when I do get them. It would be nice to not have to jump through HMO hoops if I <i>knew for a fact</i> that medicare was for sure covering the rest. (Currently Medicare is paying for everything for me... so it's a better change either way!)

 

[Tumbleweed]

Thanks guys-
<br />
<br />Yeah, I don't have the details of either plan yet, I'll be sure to investigate when I do get them. It would be nice to not have to jump through HMO hoops if I <i>knew for a fact</i> that medicare was for sure covering the rest. (Currently Medicare is paying for everything for me... so it's a better change either way!)