whats the difference between HMOs & PPOs?
Question:
Answers:
HMO=Health Maintenance Option and usually you have a "primary care" doctor who decides if you need to see a specialist for anything. Once considered a 'gatekeeper' and at one time (dont know about now) was paid by the insurance company to keep you OUT of the hospital. Poor care in my opinion.
PPO=Preferred Provider Option and it offers a choice of physicians and hospitals for you to use and those places accept giving a discount to patients seen. Then they pay (discount) a % and if so, you pay a remainder. With my PPO, a DR visit that charges $75.00 gives a $7.50 discount, actually charging me $67.50, which the insurance company picks up and pays 100% in my case anyway.
PPO is much better in my opinion. I've always have good service and no complaints.
I had an HMO once and since they didnt/dont pay for out of state emergencies unless THEY deem it an "emergency" they are a lot of trouble. Being out of state is not a factor but just another "rule". For instance while I had my HMO with METLIFE, and I lived in Florida, I had an accident while visiting in Illinois and had surgery. METLIFE said I should have gone back to Florida (yes, with a nearly dissevered hand) for the emergency surgery. Keep in mind that the time it would take that the loss of blood to hand would kill the hand, in less the time it wouldve taken to get me back to Florida. I had to call the insurance commissioner and METLIFE still only assumed a portion of the cost (after assuming NOTHING prior to the insurance commissioner putting the heat on them) If you have a choice, go with a PPO and you will have more freedom of choice. I THINK the whole attraction to the HMO is paying nothing out of pocket, but I have a PPO anyway and dont pay anything that way anyway. Good Luck.
HMO are types of insurance carriers that only allow you to utilize doctors and facilities that are in that particular insurance company's coverage area. There are usually smaller than PPOs and thus, there are less of a variety when choosing MDs and medical facilities for care.
PPOs are the more flexible options to insurance carriers. They have more variety when it comes to doctors and facilities and then to be more expensive than HMOs but you have a larger network to choose from. Almost all of the major insurance carriers have both the HMO and PPO options; for instance for Empire Blue Cross/Blue Shield, if you have the Empire HMO; and needed to find an eye doctor; your choices would be smaller than if you had the PPO version of this insurance ( but you would be dishing out less money for services if you did have the HMO). In a nutshell; pay more for the PPO of any insurance carrier you have; but across the country; you will be better off having a larger medical gene pool to choose from when you need medical care...
More Questions and Answers
- I Know People Don't Like To Talk About This But>>>>>?
- how can I unclogg my ears?
- still craving for cigerettes 4 month after qiitting?
- My toe nail is about to come off, but there is 3-4mm of lunula showing, is this the matrix?
- Can anyone recommend a good certificated basic massage course reasonably priced in Berkshire?
- Was it a tick?
- What is pain and what can you do about it?
- Is there a difference between regular corn syrup and high fructose corn syrup?