Well, it’s not quite half-price, but the HMO is significantly cheaper than the PPO - more than 25%.
However, the PPO has its advantages.
On September 21, our son was diagnosed with a brain tumor. His surgery was September 26. We were able to have doctors for our son who are among the very best in the world.
If we’d have had the HMO policy, we’d have:
- needed a written referral for the MRI that discovered the tumor;
- needed written referrals to the neurosurgery team, the pediatric team, to Johns Hopkins University Hospital;
- once the neurosurgeons decided that surgery was indicated, we’d have needed a written referral for that.
If we had Optimum Choice’s HMO (a part of United Healthcare that’s big in Maryland), we likely wouldn’t have been able to get the MRI done at Hopkins, we may not have even been permitted to go to Hopkins at all, as their network of diagnostic centers, doctors and providers isn’t as robust as that of our insurance company. But we'd have saved another hundred bucks or so per month on premiums.
With an HMO, we certainly wouldn’t have gone from MRI to surgery in five days.
As well, my previous experience with HMOs suggests that the insurance company would have used the bureaucratic requirements to essentially deny benefits, by making it so difficult to meet bureaucratic requirements in the middle of the medical crisis. I’ve had that happen before, leaving me with large, unanticipated medical bills, because I opted for the medical treatment without getting through all the bureaucratic entanglement.
No, I’m very happy that I paid the extra premiums for the PPO (essentially fee for service with few penalties for choosing any provider I wish, anywhere in the United States). I’m very happy to have paid roughly $7,000 deductibles and co-pays out of my own pocket for world-beating medical care for my son at the best hospital in the United States, with world-leading pediatric neurologists and neurosurgeons, for whom my son’s tumor was a routine, boring case.
And my son's in case, in a number of ways, illustrates some of the inherent contradictions regarding the issue of medical care and costs in the United States.
sitetest
Poor little guy! Hope all is going well for your boy!
This piece of the problem doesn't get nearly the attention it deserves. A lot of people who decide to skip buying insurance are not only factoring in how likely it is they'll really need it, but also how likely it is that if they do buy the insurance and then do need it, they'll actually get the benefits they paid for and in a timely manner. There are many aspects of the medical finance system that need changing, but this is a big one. There need to be some really punitive laws to discourage insurers from engaging in this sort of obstructionism.