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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by Racer on June 4, 2004, at 11:03:09
OK, here's the current dilemma:
My husband is now working again, and it's time to choose our coverage through his new employer. Our choices are PPO and HMO. The PPO has a six month pre-existing condition exclusion period. The HMO has none. We have to choose which one we want to enroll in.
So, you ask, what's the problem? Just take the HMO, since there's no pre-existing condition exclusion. How bad can it be, right?
Ha! The insurance company's website *says* that mental health issues go through an alternate routing system, that their customer service representative will decide what level of service you require, and will route your care accordingly. They also say up front that their model keeps costs low by relying on short term, 'problem-focused, results-oriented' approach. Reading further between the lines, when they talk about how all their providers use these techniques and are monitored for compliance with these strict guidelines, I really and truly do not want to enroll in the HMO. Maybe it's being nuts, but I would prefer a DOCTOR decide my care, not a CSR.
From my perspective, the six month wait for the PPO benefits to kick in is preferable to the twelve month wait for an open enrollment period to switch to the PPO from the HMO. I'm in hell right now, but at least it's a hell I know. The idea of changing to a new hell, especially an anticipated hell, really doesn't sound like an improvement. I'm afraid that going on the HMO would force me farther back, even if it wasn't really worse than what I'm getting now, just because it would mean making a huge change for no perceivable benefit.
Of course, that attitude *does* mean that I'm not allowing the possibility that it might be better. It might. (Based on the theory that things can only do one of three things: get better, stay the same, or get worse.) But if it wasn't better, or it was worse, then it would be much more devastating than just sticking with the devil I know.
My husband insists that the insurance rep at the outsourced HR firm handling his employer's benefit programs says the "Behavioral Health" plan is great, they'll meet all my needs extraordinarily well, etc. It's not his treatment that's at stake, though. His chronic condition (diabetes) is unaffected by any of this, since he doesn't face a pre-existing condition exclusion because he's been insured under COBRA and then HIPAA (HIPPA?).
So, instead of sitting her stewing, I decided to get a range of feedback. What do you all think? Remembering that I'm pretty fragile emotionally right now -- which, no matter how you slice it, really is an issue to consider in all this -- would you, in my position, take the risk of the HMO, or would you hold out for the PPO? (Remembering that basic physicals, etc, are not excluded. I could see a PCP for any incidentals, annuals, etc, during the six month exclusionary time period.)
Thank you very much. It's comforting to know that I can ask this question to people who won't simply dismiss this as another unreasonable fear of something so obviously a Good Thing.
Posted by Racer on June 4, 2004, at 17:16:10
In reply to Can I get some opinions? (Re: insurance), posted by Racer on June 4, 2004, at 11:03:09
Posted by Noa on June 4, 2004, at 20:32:07
In reply to Can I get some opinions? (Re: insurance), posted by Racer on June 4, 2004, at 11:03:09
Ah, insurance. And managed mental health care. It's like a game show....
"Cure that Disorder!"..."I can cure that disorder in 4 sessions". "Well, *I* can cure that disorder in 3 sessions." etc. etc.What did you decide?
Are you sure your illness isn't also covered by HIPAA? I know that there are requirements that there be no gap in coverage, etc. But when you co-insure with a spouse, do they do the coverage separately?
Posted by Racer on June 4, 2004, at 20:44:03
In reply to Re: Can I get some opinions? (Re: insurance), posted by Noa on June 4, 2004, at 20:32:07
What a great question! It does list the exclusion period on the form separately for member and dependants, though, and I haven't had coverage in years now.
Thank my stars for my husband who is the second most wonderful man on earth. We're going with the PPO, because he listened to my objections. Especially the one that I guess I was discounting: If we go with the PPO, and I see a doctor who isn't right for me, I'll be disappointed -- and be able to try another. If we enroll in the HMO, though, with all the animosity I have towards that system, I will not only be stuck with the doctor assigned to me, but I would be emotionally wrecked. All that anticipatory anxiety? All that resentment at being forced into something I am so afraid of? That would be worse than continuing on like this. At least with the PPO, I'll have access to physical health care that I'm likely to be satisfied with.
(Reality Check: I keep hearing that I am getting great care, I'm unreasonable for thinking that there's any problem with either the physical care I received recently or the mental health care I'm getting -- BUT I've never had any problems with any doctor I've seen outside the county system. Never. That just now occurred to me, guess I'll try to keep it in mind...)
I like your Jeopardy image, it really does fit their website.
Posted by shar on June 8, 2004, at 0:06:52
In reply to Hmmm.... Dunno.... » Noa, posted by Racer on June 4, 2004, at 20:44:03
Okie, dokie.....I want to know who is the FIRST most wonderful man on earth???
Sorta kidding,
SharP.S. A most affectionate Shar
> Thank my stars for my husband who is the second most wonderful man on earth.
Posted by Racer on June 8, 2004, at 11:02:25
In reply to Noa, Racer...., posted by shar on June 8, 2004, at 0:06:52
I don't know who the most wonderful man on earth is, but I know I'm not lucky enough to have found him. Therefore, my husband must be the second most wonderful man on earth.
This is the end of the thread.
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