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View Full Version : Are HMO's Good or Bad??


bailsmom
01-06-2009, 11:01 PM
My DH has been offered a position in the midwest with a decent company and their health insurance is paid at 100% :noway: We'd only be responsible for the co-pays. But the thing is that it's an HMO. We know nothing about HMO's. We've only ever had PPO's. I think at one time we had the POS, but not for very long. The other kicker is that they cover 4 IVF's. :passedout: I nearly fell out of my chair.

Yes, in order for us to have children that is our only option and I'm not getting any younger so that is HUGE plus in our book. But since we don't know how HMO's work I thought I'd ask my favorite group of knitters if they had some input, we'd really appreciate it. :)

Ingrid
01-06-2009, 11:13 PM
My insurance is through a HMO (MVP), and I really can't say I've ever had a problem.
My husband is covered under my policy. He has multiple health problems and one of his meds is over $5000 a month! I figure with all his treatments, my job is worth over $100,000 a year, even though I make a quarter of that.
When I had a single Primary Care Physician, I had to get referrals to go to a specialist--was never turned down--but now that my doctor is part of a larger group, they handle that internally. Makes life easy.
My co-pays are typically $10, and medications cost between $5 and $20.
I don't think many companies cover IVF (though I may be wrong--I'm only basing it on a couple of people at work who had to pay) so unless you have huge health issues that they may not cover, I'd definitely look into it with an open mind.
Good luck!!

Jan in CA
01-06-2009, 11:16 PM
I've mostly had HMO healthcare because everything else is too expensive. We tried a PPO a few years ago and while it was nice to be able to choose almost any doctor it was just too expensive having to pay 20-40% of everything on top of the premiums. Our HMO is Blue Shield Access+ now. I didn't like the first doctor so I tried another and I like this one a lot. I have my own Gyno and I can self refer if I want to for most anything.

What insurance company is it? There are HMOs with a less than stellar reputation, but if you do your homework you should be okay. Look up HMO comparisons and things like that to see what info you can find and if you know which one you can ask around, too.

KnittingNat
01-07-2009, 06:39 AM
I'm entirely not familiar with US health insurance system, but from the TTC knitters group on Ravelry i understood that most insurances don't cover IVF's at all and people spend a fortune on them or live their life childless because they don't have the means to pay for it. So, if they cover 4 of them and it's your only chance - i'd think about it really seriously.:hug:

miccisue
01-07-2009, 08:59 AM
I'm entirely not familiar with US health insurance system, but from the TTC knitters group on Ravelry i understood that most insurances don't cover IVF's at all and people spend a fortune on them or live their life childless because they don't have the means to pay for it. So, if they cover 4 of them and it's your only chance - i'd think about it really seriously.:hug:

A tad off topic (I know nothing about HMOs), but in IL, insurance is REQUIRED to pay for 3 attempts at IVF. As that's a touchy subject with me, that's all I'll say.

cftwo
01-07-2009, 09:24 AM
When I got this job in July, I had choices between an HMO and a PPO. The biggest difference was choosing a doctor in the system or out of the system. And since I was new to town and didn't have an already established relationship with an out-of-system doctor, I went with the HMO. I've had HMOs before, too, and have had no complaints. The doctors don't treat you any differently - it's mostly a paperwork issue.

KnittingNat
01-07-2009, 09:57 AM
A tad off topic (I know nothing about HMOs), but in IL, insurance is REQUIRED to pay for 3 attempts at IVF. As that's a touchy subject with me, that's all I'll say.
By IL you mean Israel or Illinois? In Israel we have a public health insurance, when we all pay form our paycheck and get the medical services we need (of course, with some restrictions) and all fertility treatments are highly sponsored for a few tries. Israel is one of th leading countries in IVF clinics per person number.

bailsmom
01-07-2009, 11:05 AM
Wow, thanks everyone. All I seem to hear about is how terrible most HMO's are, that's why I wanted your opinions on the matter as you can't believe everything you hear or read in the news. I don't know which insurance company it is as he hasn't accepted the position yet and we don't have any of the papers. I did try looking online about HMO's and it got a tad bit overwhelming so that's why I came here. :thumbsup: You all seem to know everything about everything. Thanks again! :muah:

miccisue
01-07-2009, 11:25 AM
By IL you mean Israel or Illinois? In Israel we have a public health insurance, when we all pay form our paycheck and get the medical services we need (of course, with some restrictions) and all fertility treatments are highly sponsored for a few tries. Israel is one of th leading countries in IVF clinics per person number.

Illinois....you know, the place with rampant corruption in the government, a (hopefully FORMER) governor who would give any pint-sized dictator a run for his money, and a nanny state of the first order. *sigh* Sure isn't the place I remember from growing up.........

Plantgoddess+
01-07-2009, 02:17 PM
My husband and I used to be with an HMO and it was ok. I feel like I get better medical care being in a PPO now. I didn't get much choice in drs with the HMO, the ones I would have selected already had reached their patient load. I found the dr dismissive of my problems (joints, bursitis, tendonitis etc) and was told I was just old and live with it. I was in my late 30's. I really had to push to get referred for treatment. They didn't even like to do minimal blood testing or physicals. This was about 10 years ago and they may have improved, but I will fight to stay in our current situation as my husband and I both really like our primary care dr. He is very thorough and we get a lot more face time with him than we did in the HMO.

dmknits
01-07-2009, 03:15 PM
I'm in a PPO. I don't know about other areas, but in my area many of the doctors have shut down their practices and have gone over to salaried positions at the HMOs. Three private practices I had been going to have all shut down this past year. My new doctor told me this is happening a lot.

Jan in CA
01-07-2009, 03:35 PM
My husband and I used to be with an HMO and it was ok. I feel like I get better medical care being in a PPO now. I didn't get much choice in drs with the HMO, the ones I would have selected already had reached their patient load. I found the dr dismissive of my problems (joints, bursitis, tendonitis etc) and was told I was just old and live with it. I was in my late 30's. I really had to push to get referred for treatment. They didn't even like to do minimal blood testing or physicals. This was about 10 years ago and they may have improved, but I will fight to stay in our current situation as my husband and I both really like our primary care dr. He is very thorough and we get a lot more face time with him than we did in the HMO.

I think this varies by HMO and plan because I've had no trouble getting testing or even the PT I had a few months ago. My doctor seems to be great, too. The first one I tried though had a horrible bedside manner, but that was his problem not the HMO. I can honestly say though having been in several that there are plans that aren't as good unfortunately.

vaknitter
01-07-2009, 11:06 PM
I think like with any insurance company you need to read the find print and see what they do when you ask for a second or third opinion before having surgery. What kind of coverage do you have if you opt to leave the HMO for specialized care, a prosthesis should ever need one....
I am in a PPO and wouldn't trade it for the world. I do not need referrals to see a specialist and I enjoy the freedom to see whom I want.
I work in the medical field and we see people who have HMO's and they tend to have really strict guidelines regarding who they pay and who they won't. People can get referrals to see our MD's, but then the HMO will not cover us to make anything they order - a prosthesis, a leg brace, therapy etc despite the fact that we work in the same clinic. Overall I find them very hard to deal with - like anyone else, HMO's are in the business of making money and the only way they make money is if you see their MD's or better yet don't see the MD - as with anything it may be regional.

You specifically mentioned IVF - do you get to choose who you work with or does the HMO employ 1 specialist and that's who you have to work with and your out of luck if you want to work with a clinic that is out of network?

bailsmom
01-07-2009, 11:25 PM
I'm not sure with regards to the IVF with their HMO. Like I said, my DH hasn't accepted the job yet so we don't have any paperwork to look at. As for the specifics, I guess compared to what coverage we have now (which is none) it has to be better. Granted they may make us jump through hoops, but since they do cover it, I'm willing to do what I have to to try and have a baby.

vaknitter
01-08-2009, 09:58 AM
You're right - coverage is better than no coverage. I'm sure the HR dept of whomever offered him the job can supply you will as much detailed info on the HMO coverage as you would like if that really makes a difference to you. Something else to consider is if the HMO has any sort of pre-existing condition clause where there is a "waiting period." I have run into companies (not always HMO's) that will say you have a 90day or even 6month wait before they will cover anything related to a pre-diagnosed condition. We have had parents switch jobs and their new insurance does this do them and they have a child with CP or CF and they are essentially without insurance for that "waiting period" while they pay premiums.

Anyway - Good Luck to you and your hubby as you make the decision to move or not to move ! Stuff like that can be scary yet sooo exciting at the same time.