the 100% directionless thread

Ewok Jerky said:
so I need to pick an HMO or PPO and I'm wicked confused. HMO is 2k deductible w/ 10k out of pocket max and like $20 copays. PPO is 4k deductible with same out of pocket max and $30 copays "after deductible". I get that HMO is managed and PPO I don't need referral, but I am confused about the "after deductible" part. So I pay full price until I hit 4k and then I still have to pay until I hit out of pocket max? Does the benefit of not needing referrals cost me 2k more?
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It's not just referrals you should consider, but what the HMO's network is, and how strictly they enforce your use of it/penalize you for going outside of it.

The PPO I'm part of has it's own network (I think that's pretty much standard) but it's much larger than the HMO I had the option of choosing, and if for whatever reason I go to a doctor outside that network, while I'll pay more, it still goes towards my deductible and max out of pocket; not so with all HMO's.

Then you have the...special...HMO's like Kaiser that require you to only use their providers, for everything, emergent and non-emergent...to the point of requiring patients to be transferred from a non-Kaiser ER to a Kaiser hospital...even if that wasn't in the patients best interests or even an appropriate move. Getting permission from places like that to go to a non-network hospital is almost impossible...and when you don't get permission...you tend to pay the full cost yourself.
 
I would go with the HMO. Usually stuff like office visits will not apply to the deductible so you just have your standard $20 copay. Referrals really aren't that big of a deal.

With the other... Every time you go to the doctor you will be paying the contracted amounts for the whole visit. Usually around $100 or so. Once and if you meet that 2k then you will only pay $30 every time you go. Then as far as hospital stays go... That's when you would most likely meet that out of pocket max. From my experience there is usually a 20% co insurance for hospital benefits. So if you have a $100,000 bill for some major surgery. Then you only have to pay 10 grand.

It is confusing. But if you are relatively healthy... The HMO is the way to go.

I did insurance billing for a few years and wanted to kill my self lol
 
My HMO is open access and doesn't require referrals to see a specialist. Plus I don't pay a dime for it, copays are cheap and my deductible isn't obscenely high.
 
Well I have a PPO but it doesn't have the same policy as what you stated. But if someone is super sick and go to the doctors all the time and is constantly admitted to the hospital. Then they would meet their max and wouldn't have to pay anything more
 
No one thinks you're funny dispatch.
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Just noticed I hit 1000 posts! *blows a kazoo*
 
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