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PPO,POS,or HMO???
Old 02-05-2012, 06:43 PM   #1
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PPO,POS,or HMO???

I've never understood the difference between these. I've always just used whatever my employer provided but i'm now unemployed and seems like i'm going to stay that way for a while. If I were going to be living in different parts of the country at different times of the year, what is best for that. I would need to have flexibility as to where I go. I'm young and nearly never go to the doctor but I want coverage for something major like a torn ACL or a car accident-related ER visit. Any advice as to which type of plan is best? Thanks
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Old 02-05-2012, 07:09 PM   #2
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PPO is what I have as it covers me all over the country and abroad. My HI comes from my ex employer in Louisiana and I now live in a different State so I had to choose PPO over POS as the company POS only covers in-State providers. I don't know if this always the case for POS, but I'm sure more knowledgeable folks will chime in.

This is a useful link I think.

Point of Service (POS) Plan Information
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Old 02-05-2012, 11:37 PM   #3
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I don't know which is best or least/most expensive, but when we had HMO coverage, we had to get referrals from the primary care docs for everything. If you never go to the doctor, you probably don't want that kind of plan--if you break your leg, you'd have to go the primary care doc or call the plan administrator to get the referral/approval to go to the ER or the orthopedic specialist.

With our PPO (United HealthCare), we can just go to a specialist who's in the network without going through the primary care. And it's nationwide.
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Old 02-06-2012, 01:14 AM   #4
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With our PPO (United HealthCare), we can just go to a specialist who's in the network without going through the primary care. And it's nationwide.
Interesting. With our PPO (also United HealthCare) they require a referral for everything. It's one of the most frustrating aspects of the plan. Perhaps the company United HealthCare has different plan options.
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Old 02-06-2012, 05:20 AM   #5
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Interesting. With our PPO (also United HealthCare) they require a referral for everything. It's one of the most frustrating aspects of the plan. Perhaps the company United HealthCare has different plan options.
That is very unusual. We also have a UHC PPO and need no referrals.
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Old 02-06-2012, 08:47 AM   #6
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Maybe we have the cheaper, creepier version of their plan. I guess that wouldn't be surprising since we seem to plan hop every year as my employer looks for less expensive plans.

I hurt my finger and wanted to see an orthopedic specialist. I was required to see my assigned GP first. She referred me to the specialist. The specialist suggests a couple alternatives, one of which was physical therapy. She referred me to their physical therapist. The physical therapist gave some general advice, but suggested I needed to see a physical therapist who specialized in hands and fingers. Each step took about two weeks, some more some less, to get an appointment. Meanwhile my finger is "healing" in the hurt position and options for correction are becoming more difficult.
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Old 02-06-2012, 09:23 AM   #7
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Looks like it would be best to narrow my choices down to the PPO options. Then i'll read the fine print to make sure I can go to a doctor nationwide. Thanks
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Old 02-06-2012, 01:15 PM   #8
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FWIW, my PPO with BCBS of Louisiana does not require referrals from a GP before going to see a specialist.
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Old 02-06-2012, 03:03 PM   #9
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Originally Posted by Alan View Post
PPO is what I have as it covers me all over the country and abroad. My HI comes from my ex employer in Louisiana and I now live in a different State so I had to choose PPO over POS as the company POS only covers in-State providers. I don't know if this always the case for POS, but I'm sure more knowledgeable folks will chime in.

This is a useful link I think.

Point of Service (POS) Plan Information
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FWIW, my PPO with BCBS of Louisiana does not require referrals from a GP before going to see a specialist.
My plan is with BCBS of MS which has a MS Physicians Network I have to work within for full coverage. But if I go out of state for services, it will be at a 50/50 instead of my normal 80/20 coverage. This is an individual policy I purchased, not through my old employer.

Are you saying your policy has network providers for full coverage through out the country?
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Old 02-06-2012, 03:23 PM   #10
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My plan is with BCBS of MS which has a MS Physicians Network I have to work within for full coverage. But if I go out of state for services, it will be at a 50/50 instead of my normal 80/20 coverage. This is an individual policy I purchased, not through my old employer.

Are you saying your policy has network providers for full coverage through out the country?
Yes, and it is 80/20 if I go out of network here in Texas, or any State.

I have put it to the test this last couple of years. I was seeing a Urologist in Louisiana before ER. Once I ER'ed I logged onto the BCBS LA website and searched for in-plan Urologists where I now live in Texas. It is a $30 copay. In November I decided I probably had Plantar Faciitis so I got a recommendation from a friend here for a Podiatrist, looked him up on the BCBS site and saw that he is also in-Plan. Again it is a $30 co-pay. I see him again this week.

Before we went to England for 7 months I called them first to confirm coverage and they told where on the website to look up in-plan hospitals for anything serious, and that any GP in the UK would be covered. The nearest hospital to where we were staying was only 10 miles away, and had an ER. Fortunately we didn't need any treatment while we were in the UK.
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Old 02-06-2012, 04:17 PM   #11
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Yes, and it is 80/20 if I go out of network here in Texas, or any State.

I have put it to the test this last couple of years. I was seeing a Urologist in Louisiana before ER. Once I ER'ed I logged onto the BCBS LA website and searched for in-plan Urologists where I now live in Texas. It is a $30 copay. In November I decided I probably had Plantar Faciitis so I got a recommendation from a friend here for a Podiatrist, looked him up on the BCBS site and saw that he is also in-Plan. Again it is a $30 co-pay. I see him again this week.

Before we went to England for 7 months I called them first to confirm coverage and they told where on the website to look up in-plan hospitals for anything serious, and that any GP in the UK would be covered. The nearest hospital to where we were staying was only 10 miles away, and had an ER. Fortunately we didn't need any treatment while we were in the UK.
Wish I had that. Mine will pay for full coverage if I have an out of state emergency like an accident, heart attack, etc(I think).

The thing that bugs me if I decide to move to another state, I better be sure I can get insurance in that state or moving is a no go.
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Old 02-06-2012, 05:08 PM   #12
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Wish I had that. Mine will pay for full coverage if I have an out of state emergency like an accident, heart attack, etc(I think).

The thing that bugs me if I decide to move to another state, I better be sure I can get insurance in that state or moving is a no go.
I'm extremely thankful for each year I have the retiree HI. The company have announced the end of DB pensions starting June 1st, and the retirees have been told to expect a big increase in premiums for 2013, which is a whole lot better than cancelling it.
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Old 02-07-2012, 01:13 PM   #13
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HMO = smallest network, usually a local network without coverage nationwide. Requires referral from primary care doctor to visit specialist. If a plan is "open access" there aren't any referrals required.

PPO = largest network, usually nationwide in the case of major insurers (BCBS, United Healthcare, etc). No referrals required.

POS = combination of the two. "In network" benefits usually use the HMO network and "out of network" benefits usually use the PPO network, or allow you to go outside the network altogether with permission. With some companies the out of network benefits still have negotiated charges that can't be exceeded. As an example, a local BCBS company's POS plans use the local HMO network as in-network and the nationwide BCBS PPO network as out-of-network. Hope that makes sense...
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Old 02-07-2012, 02:28 PM   #14
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HMO = smallest network, usually a local network without coverage nationwide. Requires referral from primary care doctor to visit specialist. If a plan is "open access" there aren't any referrals required.

PPO = largest network, usually nationwide in the case of major insurers (BCBS, United Healthcare, etc). No referrals required.

POS = combination of the two. "In network" benefits usually use the HMO network and "out of network" benefits usually use the PPO network, or allow you to go outside the network altogether with permission. With some companies the out of network benefits still have negotiated charges that can't be exceeded. As an example, a local BCBS company's POS plans use the local HMO network as in-network and the nationwide BCBS PPO network as out-of-network. Hope that makes sense...
Neat and concise summary - thanks.
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Old 02-07-2012, 02:43 PM   #15
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Neat and concise summary - thanks.
+1, helps a lot
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Old 02-07-2012, 05:04 PM   #16
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FWIW, my PPO with BCBS of Louisiana does not require referrals from a GP before going to see a specialist.

I was on BCBS of Louisiana for years as a federal employee. I was happy with the coverage, but a couple of years ago I became less happy with my premium increases, so I switched to a company called Compass Rose, that falls under United Health Care. Until last year, they were only available to feds in the intelligence community, I believe (CIA etc.) but are now open to a larger group of feds, including DoD which I happen to work for. So....I switched over. In addition to my premiums decreasing by approximately $50 per 2 weeks, my co-pays shrunk from $20 to $10, and if a routine office visit at my primary physician, is $0. I do have to pay a co-pay for any lab work, x-rays etc. Anyhow, CR is a PPO, as was my BCBS. Over 30+ years, I've tried them all, including several years in Texas on an HMO. I like the PPO type system the best, I think, and am currently happy with my health coverage. Probably won't make any more changes until I can get on TriCare in 2018.

I especially like the ability to choose any doctor, no referral required. I have found it very easy to get 2nd & 3rd opinions without the red tape associated with an HMO type coverage. I recently shopped 4 different dermatologists before letting one work on my skin caner on my face. No hassles, insurance paid up with no hesitation. I never called anybody at the insurance company to ask permission first, just pulled out the phone book and started calling for appointments. Of course, it's only smart to try to make sure the doctor/specialist you're seeing is "in network", but you're not bound by that either. It will just cost you a bit more $$.
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Old 02-07-2012, 10:04 PM   #17
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Interesting. With our PPO (also United HealthCare) they require a referral for everything. It's one of the most frustrating aspects of the plan. Perhaps the company United HealthCare has different plan options.
This must vary by state. We were with United last two years on an Advantage plan called Secure Horizons, a PPO. Never had to have a referral. Their prices went up this year so we switched to Blue Cross/Blue Shield advantage plan called Blue Medicare PPO. No referral required.
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Old 02-08-2012, 04:30 AM   #18
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I have never seen a PPO that required a referral for specialists. Possible the poster has a POS plan instead?
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