Insurance crap, x-posted to CC

[district12ravenclaw]

Steve and I need help making a decision, so I would really love some input from you fantastic ladies!

We are currently under a PPO, paid for entirely by Steve's work. But starting July 1st, the PPO will cost us $400 a month. We can either switch to the HMO, which would be free, or keep the PPO, and pay $400 a month for 10 months.

Here are the factors to be considered:
* I am 39w2d pregnant. Neither my current nor my former ob/gyn practices take an HMO, so I would have to see a brand new doctor for my 6-week postpartum check-up, as well as any future appointments.

* Steve has bad allergies, and sees an allergist who does not take an HMO either. He only sees him once a year, so this probably wouldn't be a substantial problem.

* Our current PCP takes the HMO, and the pediatrician we have selected also takes the HMO.

* Steve spoke to our financial advisor, and he told us that all things considered, it would pretty much be even over time, and that selecting a PPO vs. an HMO would be more of a lifestyle choice than a financial choice. His reasoning included that if we took that same $4000 and invested it, we would only be getting an interest rate of around 5%, and we would be taxed on it anyway. Based on our current income bracket, it pretty much evens out in the long run.

* Steve is also staring down the barrel of a promotion at work, and though it's not a sure thing, it would help to offset that cost.

So given this information, which would you choose? Thanks!

Comments

[haj.livejournal.com]

I had a friend that was in a similar situation as you and they went with the HMO plan and had nothing but problems. I would say spend the extra money for the PPO if you can afford it. You'll be spending more time and money dealing with trying to get things paid for if you go with the HMO - definitely not something you want to deal with when you've got a newborn to take care of.

[stevesbabygirl.livejournal.com]

That's what I'm afraid of; nothing but problems. We've been on the HMO before, and it was okay, but we also had PPO insurance through my work at the time, so that picked up the slack.

[sparklingstar21.livejournal.com]

I wish I was more help, but D and I will soon be in the same situation, and are having trouble justifying the money for the PPO. I will be interested to hear what others have to say.

[stevesbabygirl.livejournal.com]

Yeah, the money is just outrageous. He's in a union, and they just had a huge strike threat in November because of this, so they kept the PPO. But now, 6 months later, they're doing it again, but we're all powerless against it.

[pinkshake.livejournal.com]

We currently have PPO and it's great. When I was preggo with Alissa and about 5 months PP I had an HMO. It was great too.

I personally wouldn't spend the $400 a month on insurance, but that's me. Again, I didn't mind the HMO. I paid less out of pocket with the HMO (smaller co-payments).

[stevesbabygirl.livejournal.com]

Yeah, I can't believe how expensive it is! Luckily, we'd max out at $400 no matter how many kids we had, but still, ick.

[mwright626.livejournal.com]

I had a HMO at my last job and I now have a PPO. While the HMO I had wasn't bad, the PPO is SO much better. I don't have to go to 9 different Drs before actually being treated -- I can pick my own and only pay the $20-$30 co-pay (and I take less time off of work for appts). I really love the freedom of picking who you want to treat you and not having to deal with "policy."

That said, I'm sure that the most appts you'll have this year are with/for Owen. Is his ped covered under the HMO? I'm sure you could always give the HMO a shot and then if you are truly unhappy switch to the PPO at open enrollment.

[mwright626.livejournal.com]

Oh - and I just thought of this... My postpartum visit was already paid for (it was included in the $2600 fee my Dr. charged to deliver my baby - thank goodness for insurance!), so you might already be paying for that visit...definitely check into it (if you haven't already).

[l-lynch.livejournal.com]

Yep - I was going to say this same thing! Good luck deciding!!

[stevesbabygirl.livejournal.com]

I hope that's the case for mine!

[stevesbabygirl.livejournal.com]

Yep, the ped does take the HMO, and so does our PCP. The only one who doesn't is Steve's allergist, who he only has to see once a year, and the ob/gyn group that I switched to when I got pregnant.

[wildcat22.livejournal.com]

$400 vs. $0 is certainly a huge difference! Is there a good variety of dr's on the HMO? Do you have to have a referral to see a specialist under the HMO? I guess, what is the main difference between the PPO and HMO besides not having your obgyn/allergist on the approved list?

[stevesbabygirl.livejournal.com]

Well it's definitely cheaper all around to take the HMO option. Our prescriptions would only be $2 for generic and $5 for brand and non-formulary, can't beat that!

The ob and the allergist we both go to only once a year, so if we had to pay out of pocket, it would still be cheaper than keeping the PPO option.

[karilynne-97.livejournal.com]

Ever since working in medical collections, I'll ALWAYS have an HMO. BUT, considering the things you've got going on: Steve's specialist not accepting the HMO (why do they do that??) and your OB doesn't take the HMO, then I don't know. That's A LOT of money to invest in a PPO, not counting your deductable & copays you may have.

You'll also have to consider Owen's first year Dr's appts...there are a TON! Are WBV's and vac's covered 100% by the PPO? With our HMO, WBV's are free, no copay what so ever. Plus, if he has any forseen medical issues, that may play into that too...how much out of pocket will you be paying, say, if he has re-occuring ear infections and needs tubes put in his ears?? (Kassi needed them which is why I always think of them).

I'd look at what each plan offers and make your decisions there, not just based off of what you'll pay each month plus out of pocket expenses. Could Steve find a specialist who takes HMO's? You'll always be able to find a new OB. Find out how much you'll have to pay for Well Woman exams under each plan. What the maternity package covers (for mine, I only pay the $10 copay to confirm my pregnancy, then everything is covered 100%, even the hospital stay and delivery!!).

How much time do you have to make your decision??

[karilynne-97.livejournal.com]

I thought that I would add that Josh, with his recent medical issues, has had to be referred to a specialist, and yes, this last referral is taking longer than normal, but our medical group pushes referrals through within a day or two. Plus, with each time he was in the hospital for the month of April (4, including 1 surgery) we only had to pay our ER copay 3 times, and that was because he was admitted for the surgery, and when you're admitted you don't have to pay your copay.

So, take into consideration referrals and such, but they're not long and drawn out as some would think, at least not for us. :)

[stevesbabygirl.livejournal.com]

I think he has until Friday to get it done, but the cost is considerably less to go with the HMO. If I remember correctly, the well-baby visits are all covered.

[luvbeingamommy.livejournal.com]

Having just recenty switched from a HMO to a PPO I say do the PPO! It is worth it! Things you might want to look into first are if the plan covers well baby visits and your annual exams. Ours does with a copay.

[stevesbabygirl.livejournal.com]

I'm pretty sure the WBVs are covered 100% under the HMO, and luckily, the ped we selected takes it. We were fortunate enough to have found out about the switch before we called his office, so it works out I guess.

[luvbeingamommy.livejournal.com]

I mean does the PPO cover well baby visits? Ours does, we have to pay a copay too.

[lila-02.livejournal.com]

I wonder how much it would cost you out of pocket to see you current doctor, if you wanted to do the post-baby appt with him/her?

[stevesbabygirl.livejournal.com]

No clue, but if it isn't covered with my maternity care, it probably wouldn't be that expensive. I'd rather pay the out of pocket if I have to.

[kellygibson.livejournal.com]

i would trust your financial advisor... but if you took the HMO would you have a problem finding a doctor for your pp check up (etc)? $400/mo is a lot of money, but it may be worth it.

[stevesbabygirl.livejournal.com]

I have no idea about finding the doctor for a PP checkup, but a lot of ladies here seem to think that the checkup is covered by what I've already paid, so hopefully that's the case.

[cat-loverpq.livejournal.com]

I have an HMO and I've never had any problems with referrals. As others have mentioned, I think you need to look at what each plan covers and not just the additional cost involved. Personally I've found that with the HMO I pay less out of pocket for basically the exact same coverage as our PPO offers. If that's the case here, I would go with the HMO.

[stevesbabygirl.livejournal.com]

Thanks!

[mama-gryphon.livejournal.com]

I usually go with the PPO, because I like the fact I can see whoever I want and as long as they are in the network the cost isn't outrageous. I like that I don't have to wait for a referral when I want to see a specialist or take Alex to an eye doctor. It's expensive and the deductible usually leaves something to be desired, but I have a freedom my HMOs never gave me.

[stevesbabygirl.livejournal.com]

I didn't even think about the eye doctor, but I think our plan for vision care is separate from the health care. I hope so anyway :).

[mama-gryphon.livejournal.com]

Usually it is and there's like only one eye insurance program out here (VSP) so everyone takes it. But mostly my OB/GYN has to take the insurance or I won't switch. I've been with him about the same time I've been with my hubby and I would have serious issues switching.

[sweetjezebel.livejournal.com]

As a person who goes to doctors A LOT and is even admitted to hospitals on occasion, we're quite happy with our HMO (Blue Shield). We've talked to some of the guys at the station who have PPO to see what their feelings are on it and they aren't happy. Also, unlike a lot of stories we've heard about getting the run around on doctors, that doesn't happen to me. I have a great PCP, rheumatologist & neurologist. I even got sent to UCLA last week under this piddly little HMO! :) I say save the money and if you're not happy then switch to PPO when the next time comes around that you're able to change.

[stevesbabygirl.livejournal.com]

Oh good! We're going to have the Blue Cross HMO, so I'm assuming that would be pretty close to what you're getting with yours.

[sweetjezebel.livejournal.com]

Yes, I'm sure they're very similar. I hope you have as good of luck as we've had :)

[jenjunum.livejournal.com]

We have an HMO (HealthNet) and have always been happy with it. They even approved an allergy med that my doc said they wouldn't (we thought I could be allergic to claritin). I've never had a problem getting a referal (I've been referred to a dermatologist and an eye specialist (not a regular eye doc, the Jules Stein Eye Institute). But UCLA is my medical group, so it mgiht be a little different since everything is in the same place. My delivery is only going to cost me $250 (the amount I have to pay for any overnight visit). All prenatal and infant visits through 2 years are free. I wouldn't pay $400 a month. That's A LOT of money. I get almost 5% in a savings account, I'm not sure why your financial planner said you would only make 5% if invested. Why not put that money into your retirement? You'd make a lot more than 5% and wouldn't pay taxes until you retire? That advice seems off to me.

[unfshine.livejournal.com]

I've had both - I would say go with the HMO. You can find many good doctors and it will save you alot of money in the long run, monthly and with medical bills. :)