Hmo's PPo's Pos's insurance

[Nobody Special's wife]

There are alot of health insurance, out there But did you know that HMO'S is only a selective of doctors that you can use, So basically if you had HIV you would not be accepted in the insurance claim if your now getting insurance....

PPO, is a directory of doctors around you where you live, You can choose you doctors as you chose, As well most medical is covered.. also most of this insurance will accept almost any medical you already have...

POS, This is also a good one its just like the PPO. But it also has a list of doctors for your use. only you have to be atleast a year free of medical problems.. for example endometriosis... or no systems of the medical problem.


I find this tells you lot about your insurance, I would recomend to all of you to check your insurance you might be getting the short end of the stick so to speak. For those who don't have insurance , There is an insurance called COBRA, I found it is one of the top 10 out there and they will be happy to help you with what you need .. If only the goverment could help some of the people that work, Who need insurance. The goverment is to busy looking at the baby boomers. For us men and women who are under the age of 20 - 30 ,Find insurance or even getting insurance is hard for us,

Just some little info I thought you all would like to know

The Wife

 

[Ksss]

I have found that most people pick HMOs mainly because their premiums are affordable, but in the long run, who the hell wants to be told which doctor they can and cannot see...not me that's for sure...and loopholes, watch out for them...some have it so that if you require emergency medical treatment in an ER, you have to get a confirmation number before you are treated for the insurance to pay, otherwise you are on your own to foot the bills. Read the policies very carefully on what they cover and what they don't, just because it is affordable doesn't necessarily mean it's good....

 

[Nobody Special's wife]

Kss

That is true but the PPO is actually cheaper and its more affordable to the low income than the HMO, Think of it this way. IF you go to the ER you have to pay 200$-500$ just with out insurance, bUt if you have a PPO you only have to pay 50$ now tell me which is cheaper, I found that with PPO you can have more choice, to your needs not to the Physican or the Insurance needs...

 

[Ksss]

Very true...I have Blue Cross/Blue Shield of Central NY...I chose this insurance because it was the insurance I intially had, through my ex, when I was first treated for endometriosis and because I have an ongoing condition with my endometriosis, the insurance has paid 100% for the last 6 surgeries I have had. I am lucky enough to have a job where my employer pays 3/4's of the premiums for me (part of my fringe benefits).
I guess what I was trying to say, is for people who are looking for affordable insurance, beware of the HMOs, read the policies closely. Alot of times there are other policies out there just as affordable, but with better coverage.

 

[TN_Vixen]

I sell group insurance for a living

And you're misinformed like most people are about insurance.

PPO and POS are types of NETWORK insurance that allows you to get higher benefits as long as you stay within the network of physicians and hospitals. They are not necessarily limited to your area, however and they do NOT restrict any type of medical condition as pre-existing as long as you've had continuous coverage for 12 months.

A couple of years ago, legislation HIPPA was passed that did away with "pre-existing conditions" and it is now illegal for group insurances to disallow coverage for medical conditions as long as you've been continuously covered for 12 months.

COBRA is a continuation of coverage when you no longer have group insurance. If you lose your job or your company decides to not carry a group plan any longer, you have the option (as long as your company has 20+ employees) to continue your coverage through COBRA. It is basically an extension of the current plan your company has implemented.

Furthermore, pregnancy is no longer considered a pre-existing condition no matter what.

Any questions? *smile*

 

[Ksss]

TN-Vixen, hi, I was not refuting the fact about HIPPA, I knew that. I guess, what I was trying to state, and did a poor job of it was, my insurance pays 100%, I don't pay anything (except for the premiums). If I switched to a different insurance plan, I know they have to cover me since there was no lapse in coverage, but they may not cover the same as I currently have. Yes, I did know that the COBRA was the insurance you picked up after you terminated a job, which here in NY state is only good for 18 months. And I also knew that PPOs and POS were the networks, as I just had to look through a list of them for my son who was hired permanent at his job. I was agreeing to the choice of personal rather than physician, etc.

TN-Vixen? Can I get your opinion on HMOs, since you sell this type of insurance?

 

[TN_Vixen]

Ksss

my post was directed primarily at the thread starter, in this case NSwife.. sorry if it appeared that I was directing my post to you.

My opinion about HMO's is that they've been given a lot of bad press. They have been forced to clean up their act over the past several years and are, in fact, not really much different anymore than a regular PPO. Used to, HMO carriers would only pay a specific amount for certain procedures and some even went as far to try to diagnose a patient - determining whether women (for example) needed a full hysterectomy or a partial hysterectomy.. based on their analysis. These type of practices were done of course to save the HMO carrier money and end-resulted in a lot of lawsuits.

Now, basically the HMO carriers pay usual and customary charges just like PPO Network carriers but focus primarily on preventative care so as to avoid any major claims in the long run. AND, they use what is termed a "gate-keeper" or a Primary Care Physician who determines the need to visit a specialist and must give referrals in order for the person to have a specialist visit paid for by their carrier.

HMOs are not bad products, but since they do focus on preventative care, they are a little more expensive than PPOs and POSs.

Did I address any questions you may have?

 

[Grrrn38]

Vixen, I agree that HMOs have been victims of bad press (often their own) and have cleaned up their acts considerably recently, particularly in the Northeast, California, and large metro areas.

But there are still a lot of bad HMOs out there, particularly in areas where they're the only game in town or in states where state insurance regulations are more lax than in others.

I say this not to warn others off of HMOs -- I've been in one for 15 years and am extremely happy with my treatment for a couple of serious chronic illnesses -- but to point out the importance taking responsibility for being an informed consumer and investigating your options before choosing.

Also, Ksss -- I've always found the point about not being able to choose my own doctors in an HMO curious. I wouldn't know the first thing about choosing a cardiologist or an oncologist, and even if I did, I would trust my primary care physician's recommendation over my own uninformed opinion. But I agree that if you don't like the looks of any of the primary care docs in the network, the HMO isn't a good bet.

 

[Ksss]

Yes you did TN-Vixen, thank you! And no offense was taken hon... Grrrn38, yes, I agree that some people are better suited with an HMO, my personal preference is a non-HMO. I realize each state has it's own rules and regulations governing how some of the HMOs work. I have also have been referred to doctors I would not have had a clue who to choose. I have had the same type of coverage with VlueCross/Blue Shield for over 20 years, and as I said before, did not want to switch over to an HMO when my COBRA ran out. I guess the bottom line is, when looking for an insurance company, choose one which fits your needs the best.

 

[Closet Desire]

What goes around...

...comes around.

I don't have any choices at all. I'm covered by the NHS here in the UK. Some people like to refer to it as "free" healthcare, but as I prepare to write a check for nearly $11,000 for taxes I have to say there's nothing free about it. After a few calculations of how much goes to the NHS it turns out that it's more than I used to pay for health insurance (fully self-funded) in the US. Eeeeek. It gets worse.

If I need a CAT scan it might take 18-24 months to get it. Medications are not covered. If I need surgery it will likely be rescheduled many times due to shortages of hospital beds, surgical equipment, and staff. Hopefully I won't die of the disease before I get treated...quite a few do however.

Right now our medical system is plagued by scandal and misconduct such as apathy by some doctors, the selling of baby organs, and grossly overworked junior doctors. Nurses are so poorly paid that the shortage is being filled by recruiting nurses from Spain (which has excellent health care).

It's hard to believe that eight years ago Hillary Clinton was wanting to model a national health care system in the US on this system. Perhaps the solution for low-income, uninsured people in the US is an indigent program paid for by the isurance carriers (of course this comes from those who do pay for insurance). The US has a fundamentally good health care system, by comparison, so plugging the loopholes seems a lot easier than revamping the whole system. Even with all the HMO controversy the care is generally excellent.

This isn't an indictment of the health care professionals in this system because there are many dedicated, hard-working, conscientious people. They are trying to do the impossible with nothing to work with. Likewise, I don't see doctors in the US as greedy, but like the rest of us...working hard to do what they love.

Just my thoughts.

 

[TN_Vixen]

Closet Desire...

nice way to put things into perspective for us whiney Americans, eh? (smile)

Universal governmental sponsored health care will be practically impossible to pursue in the US for many reasons.. one obstacle being the AMA. Pharmaceutical companies are right on their heels. Right now the rising cost of group health care is due to having pharm. companies mass producing a plethora of medications written out for use by doctors to patients who manage cost of these medications through their Rx card ($10/$20/$35) deductibles.

Did you know that coverage for a single person in a group plan used to be approx. $100/mo just last year and now, the cost is approx. $165/mo for the exact same plan due primarily to the rising cost of having a drug card? It is ridiculous!

Closet, when US businesses get to the point where they can no longer afford to offer health care coverages to their employees, a lot more people will be uninsured than are right now... this translates into less procedures being performed, less money coming into the physicians hands and less quality all-round of health care for the US. If we cannot find a way to manage these costs, the US will be looking at a similar situation in the years to come.

 

[Closet Desire]

I should probably...

...clarify. I am American and ran businesses in the US for nearly two decades. My last year there, 1996, I was spending approximately $400/month for health insurance for me and my family. Since we basically owned our own business we didn't get a subsidy from our employer. Of course, nothing's free, even if your employer foots all or part of the bill. Whether it's taxes or premiums somebody foots the bill...that someone is "us".

I don't really (personal opinion here) believe that there is a conspiracy by the pharm companies or the doctors to screw the public. Besides, a lot of those pharm companies are actually based in Europe. It's expensive to develop drugs and put them through trials for each country that requires them. At least in America (if you have insurance or money) you can get these new drugs. Here, they are often not available at any price.

The one positive thing I can think of that we have here that America could use is a cap on litigation. A large part of the cost of health care in the US is simply doctors and hospitals covering their liability with extra tests and exams which usually prove unecessary. When an individual, and their team of attorneys, can achieve a settlement in the millions for a bad procedure or missed diagnosis, everybody pays in the long run (no free ride for anyone).

We all live healthier, longer lives because of medical science, but doctors are only human and they do make mistakes....even careless mistakes. The odds are still that good health care will ensure a long healthy life undreamed of just over a hundred years ago when science still didn't even know what a germ was. Medicine often seems to resemble the legal profession in its adversarial tendencies. Health professionals want to see people cured and survived. They want to see them be healthy in the same way that I want to write good books that people will by.

Maybe it's old age creeping into me to accept that perfection is an honourable, but unattainable goal and that we shouldn't lose sight of the overall benefits health care has afforded us. Maybe we should do the unthinkable and ask ourselves if there is a point where health care is "good enough" and accept the mistakes and loss of life or quality of life that accompanies mistakes and oversights.

Of course, if it's me then I want the best damn medicine and doctors science can offer and I suppose that's the rub. We're not talking about a toaster or a car, we're talking about the most precious commodity most of us have...our very lives. So on we go after the fountain of youth.

 

[TN_Vixen]

Re: I should probably...

...clarify. I am American and ran businesses in the US for nearly two decades. My last year there, 1996, I was spending approximately $400/month for health insurance for me and my family. Since we basically owned our own business we didn't get a subsidy from our employer. Of course, nothing's free, even if your employer foots all or part of the bill. Whether it's taxes or premiums somebody foots the bill...that someone is "us".[/I]

$400 per month for good health care for family coverage is not that expensive considering now it is upwards of $550 depending upon the size of the group and the type of coverage.. and mainly it is due to the rising cost of prescription drugs.

I don't really (personal opinion here) believe that there is a conspiracy by the pharm companies or the doctors to screw the public. Besides, a lot of those pharm companies are actually based in Europe. It's expensive to develop drugs and put them through trials for each country that requires them. At least in America (if you have insurance or money) you can get these new drugs. Here, they are often not available at any price.

Oh I don't believe it is a "conspiracy" per se, but I do believe that the fact the market as been saturated with new medications for just about any ailment has caused those who can to utilize such medication therefore drawing the cost of prescription coverage through the roof.

The one positive thing I can think of that we have here that America could use is a cap on litigation. A large part of the cost of health care in the US is simply doctors and hospitals covering their liability with extra tests and exams which usually prove unecessary.

That is not so true anymore. Approx. 3-4 yrs ago, you would be correct in that this was the primary reason why insurance increased in America. But now, there is such a tight hold on what is "usual and customary" for tests that the insured ends up picking up the cost for superfulous procedures and not the insurance company.. therefore the cost isn't added into trend factors.

Of course, if it's me then I want the best damn medicine and doctors science can offer and I suppose that's the rub. We're not talking about a toaster or a car, we're talking about the most precious commodity most of us have...our very lives. So on we go after the fountain of youth.

me too CD.

 

[Closet Desire]

wow...

...what a pleasure to read your response. It reminds me of that line in My Cousin Vinny when the judge looks down at him and says "that was a logical, coherent, and well-structered objection...objection denied!" (I love that movie). Hee hee. (not a dig by the way...my sense of humour can be a bit wry)

It is a complicated mess isn't it? I know some of the new drugs are real marvels and potent in their purpose like a lot of the heart medications and what not. Others though, like you, I wonder about.

I grew up in a family of hypochondriacs where your status was measured by how rare and how serious your disease was. Usually the latest one being bandied about on General Hospital. Arthritis seemed to run rampant in my family and they were always touting the latest thing the doctor had given them. My last few years in the Navy they had been trying to treat a degenerative bone problem brought about by an injury, although it was clear that nothing was going to stop it. The last ortho-surgeon I saw gave what, for me, has been the best advice. He told me that all sorts of drugs were out there to treat it, but the best one was still plain old aspirin. Over the years I decided that he was right. I know it's not always the case, but like I suggested we just have to draw a line and say "it's good enough" and, in my case, it is.

It's funny but the problems you talk about could be one of the main reasons I'm not able to move back to the US. CD-able is British and has chronic asthma (what Brit doesn't?). She won't be eligible for Medicaid and insurance will probably be through the roof as we approach our twilight years so the Med islands are looking good.

Best of health to you...

 

[TN_Vixen]

CD-- and to you too..

enjoyed the conversation.

 

[Nobody Special's wife]

I was not trying to make Hmo a bad thing, But I like my options to open that is sure. I also know that we being usa, There are alot of people that can afford it or don't know how to get it because there Jobs don't have it or the part time people can't get it and they have to wait for a fulltime postion. This I find really sad. To say the least I'm in a predicament that Even if I get health insurance it will not pay for my surgery I need or that I have to wait a year to get surgery, To top it off this surgery it self cost around 5000$ if more and its considered a major surgery, Even as an out patien. so what do I do then?

 

[Ksss]

Wife, check with your hospital and see if they have some kind of plan to help cover the medical costs, or if they know of an agency which does this. Also, look into some of your local chapters and associations (Shriners, Elks, etc.) sometimes they look for things like this, it's a good tax deduction for them. Good luck!