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Insurance HMO vs. PPO?

Wed, October 06, 2010 2:32 PM

Hey all,

I have UC. and within the last year have been hospitalized 2x bc of it and am still paying off bills from a year ago. Now is open enrollment with my employer and I have a choice to make between HMO (AvMed) and a PPO (Blue cross blue shield).

Could anyone share the experiences they have had with these two? or even just generally between HMO vs. PPO?

Any info stories appreciated.
Ash

izzymovielover
Joined Feb 12, 2009

Sat, October 23, 2010 11:23 PM

Reply posted for izzymovielover.

I dearly love PPO's.

The first major hospitalization I had produced a bill of $21,000. Once it hit UHC, they knocked the bill down to around $11,000, of which we paid maybe $400.

I love the part where the doctor/hospital receives the contract rate for the procedure/whatever and is not supposed to bill you for the rest.

That said, I have not had any experience with HMO's.

But PPO's will be more expensive.

jeffdc
Joined Aug 25, 2008

Fri, October 08, 2010 10:56 PM

Reply posted for izzymovielover.

Hi Ash:

It's good that you're concerned about this now and not waiting until Dec. 31 to ask these questions.

You need to first check to see which ins. your primary care Dr. is affiliated with. A good primary is worth a little extra in premiums.To me confidence in a primary is the most important. Also look at all the costs involved. Co-pays, hospitalizations, meds. X-rays and other out patient tests.

Ususally a HMO is less expensive but has restrictions. You cannot go to any Dr. or hospital. Only certain drugs are on the formulary. I have 1 med. that is not covered and my Dr. makes sure that I get samples.

Because I have medicare I don't have outrageous costs. My max. hospital bill is $ 500.00. Open heart surgery and 9 days in hosp. was only $ 500.00. That was all Drs. intensive care etc.

Good luck and do your homework because you cannot change for a year. Marilyn

marilynaz
Joined Jun 4, 2008

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