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Choosing Insurance Options?


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  • Choosing Insurance Options?

    [Choosing Insurance Options?]

    Author: John (---.buff.east.verizon.net)

    Date: 08-18-02 17:49


    Our oldest daugter, Kate, age 7, was diagnosed with HCM about 1 1/2 years ago. We have had her on Inderal (propranolol) for the past year with no ill effects or adverse reactions. She is doing very well with only the occasional shortness of breath when walking for some time. We have been HCMA members right from the start.

    Our question...

    We are about to change insurance plans due to an employment change and are faced with the usual decision. Do we choose from the 3 HMO style plans, or go the traditional Blue Cross/Blue Shield route? Does anyone have an opinion on this one? All of the plans seem quite similar, although, the traditional Blue Cross/Blue Shield plan is more expensive.

    We were rather concerned after seeing the movie "John Q." recently where the main character's son was denied a heart transplant due to insurance regulations. Does anyone have any experience or advice?

    Thanks Much!

    John & Suzanne


    [Re: Choosing Insurance Options?]

    Author: Lisa Salberg (---.dyn.optonline.net)

    Date: 08-18-02 19:47

    HI guys,

    Yes I have some experience and some advise.

    1. I run a health plan in my "real" job and am very familiar with the various options.

    2. HMO's can be ok and they can be a cost savings...however they are very limiting.

    I would do several things...

    A. Look at the doctors in the HMO networks ask in advance how to get to specialists for the treatment of rare conditions. You may get lucky and find high quality docs in the program. You also want to check fro high quality hopspitals. Check on Mayo - Cleveland - Mass General to name just a few.

    B. If you find that an HMO will allow you to go to these centers then it may be fine. However if you find the networks Limiting by a poor choice of doctors and a poor selection of hospitals..then the traditional BC/BS plan may actually be more cost effective in the long run. If you are caught in a bad HMO then the cost of specialist will come directly from your pocket (not something anyone wants).

    C. Make a choice that make you feel comfortable. The last thing you need to do is worry everyday.."what if..." and have the concern of unexpected healthcare costs over your family.

    How do you check out an HMO??

    Most have websites that you can check on participating doctors and medical centers. HOWEVER you must first find out exactly what plan you are being offered (there are no fewer than 6 blue cross/blue shield programs in NJ...and every state has there own plans!)

    As your Human Resource department for the information on the plans.

    In addition, if you are making a contribution to the healthcare plan (which over 90% of americans do) you are entitled to recieve a complete plan document within the first several days of enrollment ( I think it is 10 it maybe as long as 30days). If the plan does not offer you everything you had thought based upon the materials given to you by your employer you can switch - -but you must do it right away -- you can not wait 2-3 months, it must be done fast. So for all of you who take the books and stick them in a drawer until you need them....bad idea!...read the books (I know it is dry and boring but it is important).

    To answer your question as to what should you do,,,, it really depends on the plans your being offered. Sorry I can not give a better answer.

    If you need additional help please call the office.

    Best wishes,



    [Re: Choosing Insurance Options?]

    Author: Sarah B--Board Moderator (---.client.attbi.com)

    Date: 08-18-02 21:39


    I have been in an HMO and I've been in a POS and in a PPO. I will never, ever, ever be in an HMO ever again if I can avoid it. Medication choices were made based on what was "in formulary" as opposed to what I needed. Doctors I never saw were my "doctor of record." I could never see my cardiologist without first seeing the PCP who could do nothing for me whatsoever --so two or three hours down the drain just to be able to make the appointment that I needed in the first place. Had to change all my doctors since none of mine were in the plan. While it costs a little more each month to be in the PPO or regular plan, the overall savings in time, money, aggravation and your health and well being are immeasurable.

    That being said, maybe others have postitive HMO experiences they would like to share.

    Good luck



    [Re: Choosing Insurance Options?]

    Author: Jerry Salzman (---.indy.rr.com)

    Date: 08-18-02 23:45


    I have had different HMOs for years. I have never had real problems with the HMOs as long as we were dilligent, and they were not clinic based. I have to go through my PCP, but basically I just tell them what we want and they get us the referal.

    This was before I needed open heart surgery. I never thought there would be a situation where I would not want the doctors in my network. When my son was sick 3 years ago they let us go out of our network (but still in the insurance plan) so we could go to the local experts at the children's hospital. However, now I need a myectomy and I want to go to the Cleveland Clinic. There is a chance I may get approval, but I have had to beg, plead, threaten, and anything else to get this far. I will probably switch to Blue Cross in January. Although it may cost a little more, having the ability to go to any doctor is worth it.

    I am not saying do not go for the HMO, in fact we may keep it if I get the approval. However, before you decide to go with the HMO, be sure you will have access to experts you need.

    Hope this helps.

    NOTE: This is a post from the previous forum message board.