Re: RE: ambry

[Guest guest]

HMO's are the evil spawn of .

An HMO is a Health Management Organization. Which basically means you have

people, some of whom don't even have a background in medicine, who are telling

you what kind of care you should be getting, and whether or not you *really*

need to see that specialist, or you *really* needed to go to the emergency room,

etc. You generally have to choose a specific Primary Care Physician, and if you

need to see, say, a ENT doc, you have to be referred by your PCP, and get

permission from the HMO. They are very big on you getting their permission

before you get anything done, and very big on not paying for things if they can

find a way to red-tape their way out of it. Bastards. (Sorry, I've had a VERY

bad experience with a specific HMO, that was our only option at the time. Over

TWO YEARS LATER, we're STILL trying to get the insurance mess from my daughter's

birth straightened out...to the tune of like $14,000...which was slightly less

than half the bill. I'm not the only one. The company stunk so bad that my

husband's fellow employees told management in no uncertain terms that it had

better not be around for a second year. It wasn't, thank everything! This was

a well-known national HMO, too.)

A PPO is a Preffered Provider Organization. You get a list of docs that your

insurance company has a deal with on pricing. You see those docs, they cover

more of your stuff because they get a good deal. PPO's are better, in that you

can generally change your PCP as often as you want to, and most will let you go

see a specialist without you having to call the insurance company to make sure

it's ok. They sometimes still require that your PCP refer you to other doctors,

but they generally leave decisions of whether or not to do so up to you and your

doc.

What I've got now is slightly different. It sort of falls into the PPO

category. We have a list of doctors we get better deals from, but we can go to

any doc we want to. We've got basically a spending account given to us every

year by the insurance company. We can go to the doc as much as we need/want out

of that money until it runs out. After that, we pay our deductible. After

we've hit all the deductible, everything's covered 100% again. And well-care

doesn't come out of the account...it's just covered. So Triana's immunization

shots, and my husband's yearly physical, and my yearly female exam and physical

are all covered 100% if we go to one of the docs on our list. (80% if it's a

doc not in the network.) The same for prescriptions. Comes out of an account,

then the deductible, then 100%. It's wonderful to walk into the pharmacy and

have a $0.00 co-pay on meds! I'm so glad we've got this company next year, too.

They've been great this year. No problems getting them to pay for stuff, they

let us know what we actually had to pay after we spent our account, and they

just paid the rest of it. Period. It's just wonderful. Still trying to decide

if I want to go ahead and get my nose surgery done this year just because it'll

be totally covered...but not sure I really want to do that...erk...(I've got a

deviated nasal septum and polyps...specialist says that should fix my remaining

sinus issues...the tonsillectomy helped a LOT.)

Anyhow...sorry for the longwinded reply....and this may just be my experiences,

but hey...

Shanna

mom of Triana, age 2 wcf

ambry

>

> Ok, quick question. How much did the Ambry Genetics test cost you. We have

>

> an HMO so that is out of the question.

>

>

>

>

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