Switching from an HMO to PPO

I'd keep the ppo, hmo's are horrifying when you really need some help. Too many hoops to just through to get to a diagnosis.

We had an HMO because we are 'healthy', & I thought we'd save the money. Then I had to have an emergency root canal & had an awful experience with the HMO dentist, you are just a number with them, not a patient. So we switched to PPO & will never go back.

We prefer a PPO because we can't stand being told who we can see and when we can see them. Most HMO's are cheaper, but they can severely limit your freedom, especially if they have strict pre-authorization policies. Ask lots of questions before switching and find out what the rules are with the HMO. Have your husband ask other people at work what their experience has been with the HMO. It'll tell you a lot about what to expect.

We always chose the more expensive PPO over any HMO offered by our employers. I am happy we did. When I was pregnant with my daughter the HMO would have not paid for midwifery care and I would have not been able to pick the hospital I wanted to deliver at.
It's important for me to have a say in my healthcare decisions, including choosing my provider. I would only choose a HMO as the last resort.
Good luck!

.

There are so many things to consider when making this decision. One of the most important is who is in the provider network. Some physicians don't take PPO's and some don't take HMO's.
You need to consider what your health needs are and what the plans cover before/after deductibles, etc.
I chose an HMO through my employer because of my health issues. The premiums were higher, but overall, my out of pocket expenses were MUCH less with the HMO and I had no trouble getting any of the services I needed.
It depends on the carrier, it depends on the provider network...you just have to look at things thoroughly.
Figure out, worst case scenario, what your annual out of pocket maximums would be under each plan.

Best wishes.

we love our PPO & I hope/pray we never have to give it up!

Look carefully at the comparison sheet. We switched from an HMO to a PPO and now have an HSA, which we really love. Do you have that option?

I made the switch and here in Texas, I'm happy with our transition. We are relatively healthy family, so it's not inconvenient the few times we needed to go to our PCP before a referral. We have never been denied the request for a specialist. With our daughter, we figured that if anything happened we would go to the pediatrician first anyway, so why bother having options for her. With our coverage it was cheaper for me to be on the HMO when I had my daughter than if we were on the 80/20 split with the PPO. The only problem we had was when my husband needed physical therapy we needed to pay the $50 co-pay each visit, however, it was still much cheaper than the added out of pocket expenses we would of had with the 80/20 split and the price difference we would pay each month between the 2 plans. In three years, My husband and I have had multiple x-rays and MRIs, I had a baby by emergency c-section, my daughter had a blood disordered that required multiple weekly visits to a hemotologist, my husband has had surgery and physical therapy and everything has been approved for coverage. My husband even had to go to an emergency room 4 hours away (still in Texas though) and we had no problems with coverage.

I guess it depends on what state you live in. When we lived in MI we had HMO and loved it. we had to have our PCP authorize any sort of work like having to see a dermatologist for skin cancer body check all I did was call him up and tell him when my apt was for and his office would submit it. I never had to go in to see him. and once you establish yourself with the differant docs you never have to make that call to your PCP for apts. I was also able to pick out any gyno I wanted and as long as they accepted our ins I could go to any hospital they were affeliated with. We also only had a $25 copay. No deductable or limit. Now we are in IN and have PPO and hate it. we have to pay for all of our office visits there is no copay. and no chiropractic care either.
Call your docs and see if they take HMO if they do your transition will be easy.

i think I undrstand, the PPO is no longer available? and the ONLY option is the HMO? Then, switch. If you do not have to switch to a HMO then don't. i am a huge fan of PPO's. I call, make an appt and I dont need to worry about getting permission to see a Dr. One of my kids has health "iisues" I would go nuts if I needed pre approval all the time.

I went from PPO to HMO to Kaiser (the original "Health Maintanence Organization") to PPO. This is over a span of 10 years, several different jobs. I think I will switch back to HMO next year because that's what my husbands job offers at no cost and I pay a bit for the PPO benefits through my work.

I was fine with PPO and HMO, I did not find the HMO to be that difficult at all. I have a pretty straightforward medical profile- a couple pregnancies, dermatology visits, thats about it. My husband occasionally sprains something. Lots of urgent care visits, sick and well-cheks for my two kids.

I would probably not ever go back to Kaiser. I loved the Doctors I had there, but I could not stand to go through "the system" every time I had to make an appointment, ask my pediatrician a question, etc. I would just like to call the Dr. office directly and talk to a nurse or MA or receptionist or whatever. Not leave a message, wait for the call back, blah blah blah.

Anyways, I would say my PPO experience and HMO experience have been equally good. The real key is getting Dr's you like and trust.

Reluctantly and sadly I will be switching from HMO to PPO during our next open enrollment.

I think it really makes a difference where you live and how many options there are. I have used an HMO and have had a fantastic experience...until they decided to drop my medical group (a large, medical university group with some of the best doctors in the city of Chicago) completely. The great thing about the medical group in my HMO was they had specialists for everything and since it was affiliated with a teaching hospital, all the specialists were well-versed and up-to-date with procedures, technology, etc.

Because I live in a huge city with several hospitals and medical groups, it was easy to find something I liked with a pretty extensive network of primary and specialty care physicians. And...it was cheap! I paid my initial $20 co-pay for each of my pregnancies - and that was it! Both of my pregnancies were high risk, and with the first one I had to go weekly and with the second one I had to go every other week.

The hardest thing about an HMO is that if you need to do anything outside of basic care, your primary care physician has to issue a referral for a specialist. Like I said, for us it wasn't a problem because with our hospital group my doctor (who was also a professor) knew the right dermatologist, podiatrist, psychiatrist, dietitian, orthopedic, and sleep doctors to send me to.

Although my doctor accepted HMO, he also contracted with several PPO plans as well. So...I don't think that patients are 'numbers' to doctors, but more so 'numbers' to the insurance medical group

If you decide to go with the HMO, pick a medical group/site that has a LARGE number of doctors and perhaps affiliated with a medical university.

I was never disappointed with my HMO...that is, until they decided to stop contracting with my medical group despite the fact that my medical group had proposed a 0% increase in their fee structure for the next year. Apparently my medical group was 'too expensive' for the HMO to keep.

If keeping the PPO is not going to hurt you financially, I say keep it. I have an HMO (always have) and I hate it. Too much red tape and waiting.

It really depends on the PPO and HMO options your plan offers. I've had good and bad experience with both. I've had Healthnet (awful!), CIGNA (marginal) and various PPOs. The PPOs I had were expensive and horrible. I would only pick PPO if you already have experience with specific doctors and you want to keep going to them. One of my coworker didn't like the negative connotations of HMO being cheap so she picked a PPO. She asked another coworker for references to the pediatricians in that network and ended up not liking the pediatrician. She's been searching for one she likes for 4 years now. In the meantime, she's always asking me for what my pediatrician recommends for everything under the sun. I have Kaiser HMO right now and I love it. Everything is online, including doctors' profile so you can pick one easily. Switching doctors is as simple as calling up and asking for an appointment with the doctor and just tell the reception to mark him as the primary care on your record. Even if you have a primary physician, you can go to any other general practice doctor within Kaiser. Getting a referral has never been a problem at all. And once there's a record of you going to that specialist, you can make an appt with the specialist on your own. Most test results are online within 2 hrs of the test. And whatever time they say it'll be done by, it's usually done by or even earlier. The labs are open Saturday and in some cases Sunday as well. I've even emailed my doctor to authorize certain tests before I go in so I can review the result with her at my appt. The best part of it, my medical costs is half of my coworker's. The only downside is my friends and coworker's gasp of horror at the mention of Kaiser. But hey, I'm laughing all the way to the bank.

Hi,

I've had both. Currently have a PPO but that's because we don't have a choice. I've found the only benefit to be that I don't have to get Doctor approval if I want to go to a specialist. But, honestly, most of the time that I need to go to a specialist is only after seeing my regular doctor and they've suggested I see a specialist and then recommend one. The price I pay each time I visit my regular Dr. is $25 (as opposed to most HMO's at $10) and to visit a specialist, my co-pay is $35. Unless, there are a lot of times, you just want to go directly to a specialist without seeing your doctor first, I think that you don't get much more for your money to be honest.

When I was on an HMO, my doctors were always more than willing to write-up whatever was needed for me to see a specialist (and at the time, I had to see a fair amount).

Perhaps, also, you get more with a PPO when you're hospitalized??? I've only had to be hospitalized twice - once for the birth of my child and another time for a laproscopic surgery.

Cobra is temporary and WAY WAY WAY too expensive - don't go that route unless you absolutely have to.

Up until recently I had always had PPO. Recently we had to select an HMO. I was hesitant at first, but I have to say, I choose an Aetna plan with Edinger Medical in Huntington Beach as my primary and I couldn't be happier. I never have a problem getting either an appointment or a referral. Communication is great, on-line messages and phone calls are always return within a few hours. I don't know if Edinger Med has a presence in Long Beach but call them and find out! ###-###-####

It really depends on where you live, the doctors, the hospitals and the network. We've had both an HMO and a PPO through the years and to be honest the networks were one in the same so it really did not make a difference because everyone wais considered "in network".

I can't say I've had a lot of procedures or tests but nothing has ever been denied. To be honest I can't recall ever needing a referral. I guess it all comes down to how good of a plan it is. It's hard to answer not knowing all the details.

Now I know there are some HMO's around here I would never want because of their network of doctors and hospitals. That's something only you would know and could judge. Good luck!

i recently switched to an HMO from having a PPO forever. Its a real trade off. i did i for financial reasons. PPO's are way more expensive. but they give you the freedom to go see any doc you want. recently after switching I hurt my knee. almost the entire reason i always has a PPO was that i have had a bunch of knee surgeries. wouldn't you know it, right after switching i hurt myself. the only bummer for me was that I had to switch primary care doctors to get into the "network" I wanted to see the specialist I wanted to. This took about 1.5 months. pain for sure. but once i was in, it was smooth sailing. I got top care (scripps) and a really good orthopedic surgeon. so, my words of wisdom is make sure you are happy with your "network" on an HMO. The only bummer is that my primary care doc is not super far away so I don't really go in when I get sick which just happened. i chose urgent care instead. to trade offs for sure. good luck!