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jmichellejjmichelle Posts: 74
edited 06/11/2012 - 8:31 AM in Chronic Pain
My husband just got hired full time. <:P Since he wont be a contract worker anymore...I will have insurance!!! :O
It kinda sucks that its through Cigna (I have heard Cigna is a bunch of buttheads when it comes to approving anything)
My question to you guys is should I choose the HMO or the PPO. There is no deductable with the HMO, but the PPO only has a small deductable. (300 for the whole family) There is no lifetime limit on either plan and there is no preexisting clause for either plan either. The HMO is 20 less a month. Help me. Which one is better for actually getting MRI's approved etc. I dont want to be stuck.



  • my official prejudice is showing
    i hate hmo's. you need approval, you don't get best meds, they are famous for denying service, the bottom line with them is the dollar. everyting and i mean everything needs to be pre approved with them. you have to go to their drs and basically you have no choice. they will give you cheapest meds and not the best ones for you
    now for ppo
    more expensive but you can choose own dr and you will get best meds and service. you don't need pre appproval. you can go out and get the dr you want and not depend on a clinic's dr. i have had it for 25 years and no complaints except for now my pain dr does not use mine, so i have to pre pay for him and my co pay for narcotics is out of this world but i would not have it any other way. some people swear by their hmo, kaiser etc. but not me. too many horror stories with hmo's.
    talk over with husband and if money is bottom line, pick hmo, if not i would go with ppo
    I have 4 fusions from L5-3, the latest last May '12 where they fixed my disc that broke.They went through my side this time. I take 40 mg of oxycontin 4x a day and 4 fenatyl lollipops 300 micro gms 4x a day.
  • I share Jon's dislike of HMO's, you are much more limited in what you are allowed to do. Everything must be done in network and must be pre-approved. The reason for higher expense of the PPO is that YOU get to dictate your medical care, many times without requiring prior approval from the insurer. I also agree with Paul, check with his HR department and get the particulars. Freedom of choice and freedom to pursue avenues in your care without having to get referrals and prior permission is a big deal!

    Congrats to your husband in landing a job! That is a feat in itself!
  • PPO is what I would choose. HMOs, IMHO, are a waste of time, make it terribly hard to go to any specialist since you need a referral, you have less choice of which doctors you see, and are nutorious for making excuses to deny a specific medicine or treatment your doctor prescribes. This is not to say that this will not happen with a PPO as well, but the chance is greatly decreased. I'm grateful to have a PPO. I was on a PPO and was switched to an HMO. I had been seeing a doctor that prescribed me Lyrica (neurologist). Suddenly, after nearly a year on the drug, my spify new HMO didn't want to cover it because Neurontin has a generic. My doctor fought with the insurance company for 3 months since I was established on the drug. He lost. But he refused to switch me off a medicine that was working, so he gave me samples until my insurance changed again. I got extremely lucky that he had samples to give; I don't want to think of what would have happened if I had to switch!

    My little sister came down with some strange symptoms that no one could figure out. Of course, my mom had an HMO. It was a circus trying to get to specialists. It took much longer than it should have.

    This is just my bias. For some, specifically those that do not need to see specialists like PMs or neurologists, HMOs work okay. Good luck in making the right decision for you!!!

    Much love,
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