School me on PPO vs. HMO

[HNL2LHC]

If you have any serious health issues PPO is worth its weight in gold. I have advanced Glaucoma with 3 eye surgeries and able to see the best Dr's at UCLA. They do not accept HMO. Recently i was diagnosed with AFIB and had an ER visit with 5 days in the hospital. My out of pocket expenses have been minimal with Anthem Platinum PPO. Many people say well I'm healthy and don't want to spend the extra money but you will regret that when you have a serious medical issue. Pay more up front or pay a ton when you have problems not to mention no access to the best Dr's.

I was born at Kaiser, medical there until about a decade ago. Then we switched out to United Heath Care as the wife’s company out of the east coast no longer offered Kaiser. We were lucky as when the wife had her brain tumor we were PPO and could go anywhere. I am with you @badgas Dave, the whole system is tough to navigate. Best of luck as you navigate the process.

 

[CLCookie]

Maybe I think too simplistic about this, I see HMO of more of a socialist program, similar to Canada and I see PPO as more of a capitalist program. In reality, I have heard horror stories about both.

I have been with a PPO for 35 years, zero issues, go to whatever Hospital, Urgent Care or doctor I WANT to go to. All my doctors share the same website program and upload all my visits and labs to this site, even I can see it all. I have had the same Doctor now for the last 8 years, he knows me and my medical history.

 

[Cray Paper]

Well, I finally received some of my health insurance, dental and prescription drug cards today. Oddly enough, they mailed a health insurance card for me, wife and 2 dependent sons. But...only mailed 2 each prescription drug and dental cards to me and my name is the only one on them. I don't know if this a Union issue or gap in the handoff in sub agency hand off?

As for PPO verse HMO, I would say PPO all day if Kaiser were the HMO. Just have to do a little research before choosing your doc, but as we all know that isn't a bad thing. I still recall going to Kaiser in 1988 with an almost amputated my middle and ring fingertips on my left hand and the nurse had me scrub all the grease out with a course brush before she would stitch them up. It was brutal and they still hurt to this day. I learned on that day coil springs, even with the correct tool (spring compressor) are nothing to take lightly.

 

[Flying_Lavey]

I will add to this......

Most of the higher end doctors at CHLA also work at Kaiser Sunset pediatrics. Also, the Covered Ca. Kaiser plan is NOTHING like the private Kaiser plans. We have gone into emergency rooms that are full but they are all Obamacare plans and have fewer allocated services at any given time per capita than the private policies. At least this is what a couple of the admitting nurses told us at that time (about 2 years ago).

When my mom was diagnosed with Colon Cancer, it took about 2 weeks from initial visit to pre-op appointment. This was about 18 years ago so I dont remember the details much, but she was in pretty advanced stages and the doctors said, at that time, if anything took much longer the results likely would not have been so favorable.

 

[badgas]

I will add to this......

Most of the higher end doctors at CHLA also work at Kaiser Sunset pediatrics. Also, the Covered Ca. Kaiser plan is NOTHING like the private Kaiser plans. We have gone into emergency rooms that are full but they are all Obamacare plans and have fewer allocated services at any given time per capita than the private policies. At least this is what a couple of the admitting nurses told us at that time (about 2 years ago).

When my mom was diagnosed with Colon Cancer, it took about 2 weeks from initial visit to pre-op appointment. This was about 18 years ago so I dont remember the details much, but she was in pretty advanced stages and the doctors said, at that time, if anything took much longer the results likely would not have been so favorable.

This is interesting

My KP plan is identical to the one I used to buy on my own, The plans coverage amounts are the same. The only difference is that I have a tax credit that kicks in to lower the premium. I still pay KP directly.

Through Covered CA I could also select the highest " Gold " level PPO from Blue Cross all the same coverages just some Government cheese to cover the difference.

 

[lbhsbz]

Well, I finally received some of my health insurance, dental and prescription drug cards today. Oddly enough, they mailed a health insurance card for me, wife and 2 dependent sons. But...only mailed 2 each prescription drug and dental cards to me and my name is the only one on them. I don't know if this a Union issue or gap in the handoff in sub agency hand off?

As for PPO verse HMO, I would say PPO all day if Kaiser were the HMO. Just have to do a little research before choosing your doc, but as we all know that isn't a bad thing. I still recall going to Kaiser in 1988 with an almost amputated my middle and ring fingertips on my left hand and the nurse had me scrub all the grease out with a course brush before she would stitch them up. It was brutal and they still hurt to this day. I learned on that day coil springs, even with the correct tool (spring compressor) are nothing to take lightly.

I've got a scar just like that...but just on the other side of the last knuckle...also from a fucking coil spring lol.

I traded the on-call guy at the Little Company of Mary carestation a couple blocks away a brake job w/ parts on his BMW for sewing my finger tip back on....

 

[Flying_Lavey]

This is interesting

My KP plan is identical to the one I used to buy on my own, The plans coverage amounts are the same. The only difference is that I have a tax credit that kicks in to lower the premium. I still pay KP directly.

Through Covered CA I could also select the highest " Gold " level PPO from Blue Cross all the same coverages just some Government cheese to cover the difference.

From what I was told, it had to do with how the resources were divided. At least that was at Kaiser Sunset 2 years ago in the middle of flu season (trailing end of the 'Vid). Things may have changed since then.

 

[Cray Paper]

I will add to this......

Most of the higher end doctors at CHLA also work at Kaiser Sunset pediatrics. Also, the Covered Ca. Kaiser plan is NOTHING like the private Kaiser plans. We have gone into emergency rooms that are full but they are all Obamacare plans and have fewer allocated services at any given time per capita than the private policies. At least this is what a couple of the admitting nurses told us at that time (about 2 years ago).

When my mom was diagnosed with Colon Cancer, it took about 2 weeks from initial visit to pre-op appointment. This was about 18 years ago so I dont remember the details much, but she was in pretty advanced stages and the doctors said, at that time, if anything took much longer the results likely would not have been so favorable.

I worked with a guy a couple of decades ago that came from a very wealthy family, he was a union carpenter but was born with a silver spoon in his mouth. When my first kid was born we were working together on a night shift and he told me his parents put him, his wife and kids on their private plan (that was paid with cash) and the medical coverage was amazing and said I should do the same. When he told me what it cost, I was shocked and said NFW could I afford that, and he didn't understand why. No lines, direct access to any doc, specialist you wanted, just another side benefit of being wealthy.

 

[badgas]

I worked with a guy a couple of decades ago that came from a very wealthy family, he was a union carpenter but was born with a silver spoon in his mouth. When my first kid was born we were working together on a night shift and he told me his parents put him, his wife and kids on their private plan (that was paid with cash) and the medical coverage was amazing and said I should do the same. When he told me what it cost, I was shocked and said NFW could I afford that, and he didn't understand why. No lines, direct access to any doc, specialist you wanted, just another side benefit of being wealthy.

Yeah there are some folks that live in world most of us will never know.

 

[Flying_Lavey]

I worked with a guy a couple of decades ago that came from a very wealthy family, he was a union carpenter but was born with a silver spoon in his mouth. When my first kid was born we were working together on a night shift and he told me his parents put him, his wife and kids on their private plan (that was paid with cash) and the medical coverage was amazing and said I should do the same. When he told me what it cost, I was shocked and said NFW could I afford that, and he didn't understand why. No lines, direct access to any doc, specialist you wanted, just another side benefit of being wealthy.

When I said private, I was referring to employer provided plans versus what Joe Schmoe could get off the street via obamacare.

But, I do know what you mean.

 

[dezertrider]

I was sitting in the ER with an X girl friend years ago right next to the nurses station. Dr. walks up refering to another patient and says we need to get this guy into heart surgery ASAP. He opens a folder and looks at the insurance and says "well fuck!" With his insurance we wont get anyone to come in until Monday. This was a Friday.

Fast forward to when I found out I had testicular cancer. I had PPO insurance and my primary got me a same day a referal to a specialest. The specialest confirmed my primarys finding. The Dr. delayed his vacation and I had surgery the next day. That was a crazy moment in my life. I will only get the good insurance now. Dr.s are a business and they work harder for what pays more

 

[Cray Paper]

When I said private, I was referring to employer provided plans versus what Joe Schmoe could get off the street via obamacare.

But, I do know what you mean.

Sorry man, this stuff is outside my wheelhouse but just sharing with others like me that had / have no idea what great medical coverage looks like. I used to think I had really good medical coverage through the carpenters union, 33+ years in and it is not nearly as good as it used to be and doesn't compare to what the wealthy receive if you buy in yearly and pay with cash, it is entirely different. That is out there if you have the cash, from the same Hospitals that our common folk medical insurance companies use. The attention given and expertise is so far above what we common folk get.