More Health Insurance Questions

[JennifersHope]

Hi Guys,

I know I ask a lot of questions about health insurance but it is a biggie for me, well for all of us really....

I am going over health insurance options for my job and I just don't know which plan to pick

I have narrowed it down to two choices..

One is a PPO.. FOr the PPO I can go to any doctor I want without having to get my primary care doctors okay, but the trouble I have is my plan only pays 90 percent of doctor visits and hospital stays......

Actually both plans only cover 90 percent which is down right freaking me out, where I am now, my hospital benefits are 100 percent covered as long as I use my hospital... so to add 10 percent is freaky to me..as I can easily rack up a $100,000. 00 bill.. I can't imagine having to owe $10,000 each time I go in the hospital.... BUt like I said both plans are that way... so yikes

The other delemia I have is the prescriptios, the PPO only covers 90 percent pf generic and 80 precent of brand names... I have a $2000.00 out of pocket max... the HMO I only have to pay $10 for generic $30.00 for brand and $40.00 for non formulary... ( Is most of our drugs non formulary?)

For doctor visits the cost is covered 90 percent with the PPO and with the HMO I would only have to pay 20 dollars.

I don't get vision care for the PPO but I do for the HMO

I always thought HMOS were not the insurance plan of choice but I am starting to wonder..

Please give me any information you can, I would love to hear from ppl with HMO's and PPO's

Thanks

 

[JennifersHope]

Hi Guys,

I know I ask a lot of questions about health insurance but it is a biggie for me, well for all of us really....

I am going over health insurance options for my job and I just don't know which plan to pick

I have narrowed it down to two choices..

One is a PPO.. FOr the PPO I can go to any doctor I want without having to get my primary care doctors okay, but the trouble I have is my plan only pays 90 percent of doctor visits and hospital stays......

Actually both plans only cover 90 percent which is down right freaking me out, where I am now, my hospital benefits are 100 percent covered as long as I use my hospital... so to add 10 percent is freaky to me..as I can easily rack up a $100,000. 00 bill.. I can't imagine having to owe $10,000 each time I go in the hospital.... BUt like I said both plans are that way... so yikes

The other delemia I have is the prescriptios, the PPO only covers 90 percent pf generic and 80 precent of brand names... I have a $2000.00 out of pocket max... the HMO I only have to pay $10 for generic $30.00 for brand and $40.00 for non formulary... ( Is most of our drugs non formulary?)

For doctor visits the cost is covered 90 percent with the PPO and with the HMO I would only have to pay 20 dollars.

I don't get vision care for the PPO but I do for the HMO

I always thought HMOS were not the insurance plan of choice but I am starting to wonder..

Please give me any information you can, I would love to hear from ppl with HMO's and PPO's

Thanks

 

[JennifersHope]

Hi Guys,

I know I ask a lot of questions about health insurance but it is a biggie for me, well for all of us really....

I am going over health insurance options for my job and I just don't know which plan to pick

I have narrowed it down to two choices..

One is a PPO.. FOr the PPO I can go to any doctor I want without having to get my primary care doctors okay, but the trouble I have is my plan only pays 90 percent of doctor visits and hospital stays......

Actually both plans only cover 90 percent which is down right freaking me out, where I am now, my hospital benefits are 100 percent covered as long as I use my hospital... so to add 10 percent is freaky to me..as I can easily rack up a $100,000. 00 bill.. I can't imagine having to owe $10,000 each time I go in the hospital.... BUt like I said both plans are that way... so yikes

The other delemia I have is the prescriptios, the PPO only covers 90 percent pf generic and 80 precent of brand names... I have a $2000.00 out of pocket max... the HMO I only have to pay $10 for generic $30.00 for brand and $40.00 for non formulary... ( Is most of our drugs non formulary?)

For doctor visits the cost is covered 90 percent with the PPO and with the HMO I would only have to pay 20 dollars.

I don't get vision care for the PPO but I do for the HMO

I always thought HMOS were not the insurance plan of choice but I am starting to wonder..

Please give me any information you can, I would love to hear from ppl with HMO's and PPO's

Thanks

 

[blondelawyer]

Does the PPO option have an out-of-pocket max? We have to pay 90% of hospital stays, home health, etc., but it is subject to the out of pocket max, so that helps. We generally like the PPO because we don't have to get referrals to go to the clinic and other specialist, which can be a hassle.

Also, take a look at the available providers under each. If one has a really restrictive group, that would be a big red flag.

Good luck!

 

[blondelawyer]

Does the PPO option have an out-of-pocket max? We have to pay 90% of hospital stays, home health, etc., but it is subject to the out of pocket max, so that helps. We generally like the PPO because we don't have to get referrals to go to the clinic and other specialist, which can be a hassle.

Also, take a look at the available providers under each. If one has a really restrictive group, that would be a big red flag.

Good luck!

 

[blondelawyer]

Does the PPO option have an out-of-pocket max? We have to pay 90% of hospital stays, home health, etc., but it is subject to the out of pocket max, so that helps. We generally like the PPO because we don't have to get referrals to go to the clinic and other specialist, which can be a hassle.

Also, take a look at the available providers under each. If one has a really restrictive group, that would be a big red flag.

Good luck!

 

[NoExcuses]

<div class="FTQUOTE"><begin quote><i>Originally posted by: <b>JennifersHope</b></i>

Actually both plans only cover 90 percent which is down right freaking me out, where I am now, my hospital benefits are 100 percent covered as long as I use my hospital... so to add 10 percent is freaky to me..as I can easily rack up a $100,000. 00 bill.. I can't imagine having to owe $10,000 each time I go in the hospital.... BUt like I said both plans are that way... so yikes


</end quote></div>

OK Step by step girl.

Most plans have an out of pocket maximum per year. So although 90% of the hospital stay is covered by the plan, if you hit the out of pocket max (maybe $1,000 or $2,000) then that's all you owe for the year.

Then if you're in the hospital a second time, costs will be covered 100%

<div class="FTQUOTE"><begin quote>

The other delemia I have is the prescriptios, the PPO only covers 90 percent pf generic and 80 precent of brand names... I have a $2000.00 out of pocket max... the HMO I only have to pay $10 for generic $30.00 for brand and $40.00 for non formulary... ( Is most of our drugs non formulary?)

</end quote></div> PPO will be much more generous with formulary coverage. And submitting a prior auth will be much easier. It can be done with an HMO, but usually they'll try to discourage you from submitting prior auths by waiting a long time to answer the claim, thereby making you miss getitng your meds on time.

If your 80% of brand names with a PPO still leaves you with a huge bill, companies like Novartis (TOBI) and Genetech (Pulmozyme) will help you with the outrageous co-pay.


<div class="FTQUOTE"><begin quote>For doctor visits the cost is covered 90 percent with the PPO and with the HMO I would only have to pay 20 dollars.

</end quote></div> I bet that HMO co-pay of $20 is for in-network docs. What if your CF center is out of network?

And I bet there is an annual out of pocket max for the POO as well, even though you have to pay 10% of the cost of the visit.



<div class="FTQUOTE"><begin quote>

I always thought HMOS were not the insurance plan of choice but I am starting to wonder..

</end quote></div>


They are hell. The do all they can to contain costs. It might seem like a wiser choice now, but if you do go HMO you will regert it.

It's sad to say, but doc's will treat you differently if you are PPO as well. Why? They earn more money by seeing a PPO patient. They will take more time with you. They will go out of their way more to provide perks and extra services because you are making them more money.

You get what you pay for - in any aspect of life.

Never cut costs when it comes to your health - cut costs elsewhere maybe with clothing, furnishing your house, vacations, etc. Never with healthcare.

 

[NoExcuses]

<div class="FTQUOTE"><begin quote><i>Originally posted by: <b>JennifersHope</b></i>

Actually both plans only cover 90 percent which is down right freaking me out, where I am now, my hospital benefits are 100 percent covered as long as I use my hospital... so to add 10 percent is freaky to me..as I can easily rack up a $100,000. 00 bill.. I can't imagine having to owe $10,000 each time I go in the hospital.... BUt like I said both plans are that way... so yikes


</end quote></div>

OK Step by step girl.

Most plans have an out of pocket maximum per year. So although 90% of the hospital stay is covered by the plan, if you hit the out of pocket max (maybe $1,000 or $2,000) then that's all you owe for the year.

Then if you're in the hospital a second time, costs will be covered 100%

<div class="FTQUOTE"><begin quote>

The other delemia I have is the prescriptios, the PPO only covers 90 percent pf generic and 80 precent of brand names... I have a $2000.00 out of pocket max... the HMO I only have to pay $10 for generic $30.00 for brand and $40.00 for non formulary... ( Is most of our drugs non formulary?)

</end quote></div> PPO will be much more generous with formulary coverage. And submitting a prior auth will be much easier. It can be done with an HMO, but usually they'll try to discourage you from submitting prior auths by waiting a long time to answer the claim, thereby making you miss getitng your meds on time.

If your 80% of brand names with a PPO still leaves you with a huge bill, companies like Novartis (TOBI) and Genetech (Pulmozyme) will help you with the outrageous co-pay.


<div class="FTQUOTE"><begin quote>For doctor visits the cost is covered 90 percent with the PPO and with the HMO I would only have to pay 20 dollars.

</end quote></div> I bet that HMO co-pay of $20 is for in-network docs. What if your CF center is out of network?

And I bet there is an annual out of pocket max for the POO as well, even though you have to pay 10% of the cost of the visit.



<div class="FTQUOTE"><begin quote>

I always thought HMOS were not the insurance plan of choice but I am starting to wonder..

</end quote></div>


They are hell. The do all they can to contain costs. It might seem like a wiser choice now, but if you do go HMO you will regert it.

It's sad to say, but doc's will treat you differently if you are PPO as well. Why? They earn more money by seeing a PPO patient. They will take more time with you. They will go out of their way more to provide perks and extra services because you are making them more money.

You get what you pay for - in any aspect of life.

Never cut costs when it comes to your health - cut costs elsewhere maybe with clothing, furnishing your house, vacations, etc. Never with healthcare.

 

[NoExcuses]

<div class="FTQUOTE"><begin quote><i>Originally posted by: <b>JennifersHope</b></i>

Actually both plans only cover 90 percent which is down right freaking me out, where I am now, my hospital benefits are 100 percent covered as long as I use my hospital... so to add 10 percent is freaky to me..as I can easily rack up a $100,000. 00 bill.. I can't imagine having to owe $10,000 each time I go in the hospital.... BUt like I said both plans are that way... so yikes


</end quote></div>

OK Step by step girl.

Most plans have an out of pocket maximum per year. So although 90% of the hospital stay is covered by the plan, if you hit the out of pocket max (maybe $1,000 or $2,000) then that's all you owe for the year.

Then if you're in the hospital a second time, costs will be covered 100%

<div class="FTQUOTE"><begin quote>

The other delemia I have is the prescriptios, the PPO only covers 90 percent pf generic and 80 precent of brand names... I have a $2000.00 out of pocket max... the HMO I only have to pay $10 for generic $30.00 for brand and $40.00 for non formulary... ( Is most of our drugs non formulary?)

</end quote></div> PPO will be much more generous with formulary coverage. And submitting a prior auth will be much easier. It can be done with an HMO, but usually they'll try to discourage you from submitting prior auths by waiting a long time to answer the claim, thereby making you miss getitng your meds on time.

If your 80% of brand names with a PPO still leaves you with a huge bill, companies like Novartis (TOBI) and Genetech (Pulmozyme) will help you with the outrageous co-pay.


<div class="FTQUOTE"><begin quote>For doctor visits the cost is covered 90 percent with the PPO and with the HMO I would only have to pay 20 dollars.

</end quote></div> I bet that HMO co-pay of $20 is for in-network docs. What if your CF center is out of network?

And I bet there is an annual out of pocket max for the POO as well, even though you have to pay 10% of the cost of the visit.



<div class="FTQUOTE"><begin quote>

I always thought HMOS were not the insurance plan of choice but I am starting to wonder..

</end quote></div>


They are hell. The do all they can to contain costs. It might seem like a wiser choice now, but if you do go HMO you will regert it.

It's sad to say, but doc's will treat you differently if you are PPO as well. Why? They earn more money by seeing a PPO patient. They will take more time with you. They will go out of their way more to provide perks and extra services because you are making them more money.

You get what you pay for - in any aspect of life.

Never cut costs when it comes to your health - cut costs elsewhere maybe with clothing, furnishing your house, vacations, etc. Never with healthcare.

 

[JennifersHope]

Oh so wait, you mean the out of pocket max is subject to hospital bills and doctor office visits as well??? That would be amazing if that is all I had to pay out of pocket for my presciptions, doctors visits etc...

How do I know if it is included?

Thanks so much for the reply.. I have so many decisions to make between work stuff, doctor stuff and the new house stuff that I am on overload...

 

[JennifersHope]

Oh so wait, you mean the out of pocket max is subject to hospital bills and doctor office visits as well??? That would be amazing if that is all I had to pay out of pocket for my presciptions, doctors visits etc...

How do I know if it is included?

Thanks so much for the reply.. I have so many decisions to make between work stuff, doctor stuff and the new house stuff that I am on overload...

 

[JennifersHope]

Oh so wait, you mean the out of pocket max is subject to hospital bills and doctor office visits as well??? That would be amazing if that is all I had to pay out of pocket for my presciptions, doctors visits etc...

How do I know if it is included?

Thanks so much for the reply.. I have so many decisions to make between work stuff, doctor stuff and the new house stuff that I am on overload...

 

[JennifersHope]

Amy we were posting at the same time.... Thanks for the reply.. I wasn't looking to cut costs with my plan, I would rather pay more up front.. I just was wondering about the presciptions..

I have a feeling the PPO is better and that is what I will chose.. I just get so freaked because I worked so hard to pay off all my medical bills and now I am so close to owing nothing that I am overboard paranoid with owing money....

Thanks for the input....

 

[JennifersHope]

Amy we were posting at the same time.... Thanks for the reply.. I wasn't looking to cut costs with my plan, I would rather pay more up front.. I just was wondering about the presciptions..

I have a feeling the PPO is better and that is what I will chose.. I just get so freaked because I worked so hard to pay off all my medical bills and now I am so close to owing nothing that I am overboard paranoid with owing money....

Thanks for the input....

 

[JennifersHope]

Amy we were posting at the same time.... Thanks for the reply.. I wasn't looking to cut costs with my plan, I would rather pay more up front.. I just was wondering about the presciptions..

I have a feeling the PPO is better and that is what I will chose.. I just get so freaked because I worked so hard to pay off all my medical bills and now I am so close to owing nothing that I am overboard paranoid with owing money....

Thanks for the input....

 

[JennifersHope]

another question.. what is the difference between out of pocket max.. which mine says will be $1500.00 for the PPO and from the deductable.. which also the PPO says is $500.00???

THANKS

 

[JennifersHope]

another question.. what is the difference between out of pocket max.. which mine says will be $1500.00 for the PPO and from the deductable.. which also the PPO says is $500.00???

THANKS

 

[JennifersHope]

another question.. what is the difference between out of pocket max.. which mine says will be $1500.00 for the PPO and from the deductable.. which also the PPO says is $500.00???

THANKS

 

[NoExcuses]

I feel ya girl. <img src="i/expressions/face-icon-small-smile.gif" border="0">

Call up the plan (or talk to HR) if you want to verify what the out of pocket max refers to.

For me, my out of pocket max applies to my in-network co-pays (for hospital visits, doc visits, x-rays, labs combined). Then I have a seperate out of pocket max for out of network stuff.

It's a lot to deal with for sure <img src="i/expressions/face-icon-small-smile.gif" border="0"> I totaly understand. <img src="i/expressions/face-icon-small-smile.gif" border="0"> <img src="i/expressions/face-icon-small-smile.gif" border="0"> <img src="i/expressions/face-icon-small-smile.gif" border="0">

 

[NoExcuses]

I feel ya girl. <img src="i/expressions/face-icon-small-smile.gif" border="0">

Call up the plan (or talk to HR) if you want to verify what the out of pocket max refers to.

For me, my out of pocket max applies to my in-network co-pays (for hospital visits, doc visits, x-rays, labs combined). Then I have a seperate out of pocket max for out of network stuff.

It's a lot to deal with for sure <img src="i/expressions/face-icon-small-smile.gif" border="0"> I totaly understand. <img src="i/expressions/face-icon-small-smile.gif" border="0"> <img src="i/expressions/face-icon-small-smile.gif" border="0"> <img src="i/expressions/face-icon-small-smile.gif" border="0">