HMO/PPO

[Guest guest]

n and Shanna,

Thanks for the answers to my HMO/PPO question. There used to be a time I

thought they were one in the same. All I knew is there were a list of

doctor's you had to choose from. Years ago, we did have a HMO, we lived in

South Carolina, very near the North Carolina border... But worked in NC,

therefore my doctor's were in NC... The hospital was over an hour away. I

was pregnant with my 2nd daughter at the time.... what an experience that

was! Now we have a PPO... all I know is I love the insurance we have now!

Thanks again

n*:-.,_,.-:*'``'*

proud momma to 3 beautiful daughters and one young prince!

Kaitlynn 11, Halie 7, Kennidy 5 & 12 wks

%%%%%

" Life is not measured by the number of breaths you take ~

but by the moments that take your breath away. "

> Re: RE: ambry

>

> 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. T!

> he 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 gett!

> ing 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

>

>

>

>

>