HMO or PPO? (plan, doctor, female, specialist)

[foma]

I'm trying to pick a plan but don't know if I should go with an HMO or PPO. I found one of each that fit my needs and budget.

Is there a stigma to HMO's today as there was 10+ years ago?

Or have HMO's gotten better with time?

I've never selected an HMO b'c everyone's like, "You can't pick your own doctors!" but I've come to realize that when I have to see a specialist, I ask my family practice MD to recommend me to someone anyway. Isn't an HMO the same concept?

Thanks all for your input.

[SXMGirl]

I just switched to a PPO because you don't need referrals.

[SouthernBelleInUtah]

it depends on your age and general state of health. If you make few doctor's visits per year, no chronic problems, HMOs may be cheaper. Any problems w/chronic conidtions, frequent visits, you want a PPO where you don't need prior approval.

[foma]

Well, I've been diagnosed with spinal stenosis recently and it will be a lifelong back problem I will have to deal with. I understand about needing to get prior approval with an HMO but I can't imagine them denying me service for something I've been diagnosed with.

I like the freedom of PPOs but I just find myself always asking my family doctor to give me referrals anyway instead of "choosing" who i want to go to so that's the main reason why I'm thinking about switching. Cost isn't a factor to me so paying that extra $100/mo for a PPO isn't a big deal. I'm just curious if an HMO is really as bad as everyone says it is.

[frogandtoad]

PPO so you don't have to deal with referrals. WAY better than HMOs. You're thinking about your back, but what about when you have some "female thing" come up or something, and you just want to call a specialist, but no...you have to call your primary first and go see him. Or whatever. If cost is not an issue, there is no advantage of an HMO over a PPO but there are advantages of PPO over HMO.

[Pikantari]

I say it is easier to have a PPO because you do not have to worry about your dr sending a referral for all of your specialist appointments.

You will most of the time need to be referred by a dr to get into a specialists office these days either way, just not the insurance type of a referral to be done by the dr.

Anymore, whenever I need to see a specialist, I cannot call and schedule the appt, the drs office has to....

[Pikantari]

Originally Posted by foma

I'm trying to pick a plan but don't know if I should go with an HMO or PPO. I found one of each that fit my needs and budget.

Is there a stigma to HMO's today as there was 10+ years ago?

Or have HMO's gotten better with time?

I've never selected an HMO b'c everyone's like, "You can't pick your own doctors!" but I've come to realize that when I have to see a specialist, I ask my family practice MD to recommend me to someone anyway. Isn't an HMO the same concept?

Thanks all for your input.

It is just about the same. The difference is that they have to either do a written or online referral with your insurance company. I agree that you will probably end up at primary care either way.

I have an HMO right now and I have to stay after the girl about doing the prior auth/referral.

I used to do those at a drs office and took care of them the same day I made the appointments for people but that is not always the case.

The girl at my drs office tells me she will just wait until I get there at the other drs office and they call her for it.

I had to let her know that is just not how it works..

[foma]

besides pikantari, anyone ever use actually use an HMO?? 'cuz basically i have the same idea as the rest of y'all, but wanted to hear "first hand" from someone.

i know i shouldn't base my decision on one thing (and i won't) but there is one (important) thing the HMO covers that the PPO does not, various methods of AI for infertility (not IVF). we're having trouble conceiving and although we're not that involved in the whole fertility process yet, we might be so if the HMO covers it and not the PPO, the HMO is looking good. my concern is if my primary care md has to refer me to a specialist (fertility specialist or for my back or any other reason) is the referral process really that much of a "pain in the butt" versus just calling a specialist with your PPO.

[Roselvr]

Originally Posted by foma

Well, I've been diagnosed with spinal stenosis recently and it will be a lifelong back problem I will have to deal with. I understand about needing to get prior approval with an HMO but I can't imagine them denying me service for something I've been diagnosed with.

I like the freedom of PPOs but I just find myself always asking my family doctor to give me referrals anyway instead of "choosing" who i want to go to so that's the main reason why I'm thinking about switching. Cost isn't a factor to me so paying that extra $100/mo for a PPO isn't a big deal. I'm just curious if an HMO is really as bad as everyone says it is.

Denying service? Sure they will.
PPO - one year I was denied injections (L5S1) - Dr wrote letter of necessity, I appealed. After 3 months they came back with, someone made a mistake; you are covered for injections. Well I knew that because I'd had them a few months earlier.

New PPO - injections to the piriformis muscle end of April - no problems. 2 months later, new injections, they can't get an approval. I have no clue what's going on and have to call next week.

btw, some of my doctors aren't in plan - they are an 80/20 split.

[christina0001]

I have used them both. PPOs in my experience are easier, you generally don't have to worry about referrals, as long as you are seeing an in-network provider.
Definitely make sure, if you have doctors that you like, that they are in-network.