1. My Endocrinologist & OB/Gyn are both in that network.
2. NO deductible!
3. I get blood work done a lot. I always have it done at the office visit. It is very expensive under the PPO. It would be included in the $20 office visit copay for the HMO.
4. I am not a fan of being forced to go to a Catholic Hospital, which I am with the PPO. I'm not catholic.
5. Josh NEVER goes to the doctor, even when he should, because he never meets his deductible and we have to pay it out of pocket. Under the HMO he could go for $20, not $200.
Is there something I am missing? The HMO just seems too good to be true. Have any of you had really good or bad experiences with an HMO or PPO?
5 comments:
When I worked out United Healthcare they told us that basically the difference between HMO and PPO is that with a HMO you must see a doctor in that network to be covered whereas a PPO has more of a choice in doctor's coverage (even out of network, you still might get some reimbursement). With a HMO you also need a referral from your primary care physician to see a specialist and you don't need that with a PPO. But since the doctor's you see are in the HMO network you don't have to worry about all of that so it's probably the better choice :) I like that there's no deductibles and that immunizations are covered at 100%. Right now we pay out of pocket to get the kid's vaccinated with CAT's ppo plan. That definitely adds up!
I'm with Jen, as long as the docs you like are in your HMO plan, then that's the better deal. The times when a PPO might be handier are if you had to go to the ER while you were traveling, or something like that. But for the stuff that's schedule-able and controllable, the HMO is probably the much better option.
It appears that HMO has a higher out of pocket max than the PPO. Overall, I really think it is your preference. I had PPO with my last employer and they covered a lot of stuff....such as my TTTS surgery in Wisconsin which was out of network, etc. Now I have POS which is still with Priority. If you have a lot of doc appts then it might be a good idea to go with HMO knowing you have a set fee versus 20%.
For us the PPO has always been the better option. I think it just depends on your location and what you are comfortable with. I pay twenty percent after the group discount, so my office visits can be less than $20, but not always.
Wow, I've never heard of a PPO that doesn't cover children immunizations! For Jason and me (and Bret), the better option has always been a PPO, but that may be because of the company Jason works for.
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