Insurance question...

Hello all! I just wanted to know if anyone has any advice if a PPO is better to have then an HMO plan to get the surgery quicker without all of the guidelines in order to be approved. I know there is some degree of waiting and getting insurance approval. I'm talking about without the 6 months diet and having to be refered from your PCP. I have heard and read of people getting the surgery within a couple of months and everything smoothly and they had a PPO Plan. Just wondering if I should switch...Thanks!

I don't know much about the differences, but I do know that in the state of CA HMO's are required to cover the surgery, and PPO's are not, so before you switch to a PPO make sure that it is covered?

There are some folks on here who know VOLUMES about the insurance companies, so I am sure you will get some great info!

Best of luck on your journey, hope to see you around here more!


Shells

I don't think it's PPO vs. HMO. It's the specific policy you have. Aetna requires either a 3 month multi-discipline program or a 6 mo. doctor supervised diet and I think you get to pick and it's not related to HMO vs. PPO.

My Aetna plan is a cross between a PPO and an HMO. I don't need a referral to a specialist -- just like a PPO -- but I have to stay in Network and pay co-pays just like an HMO. There are all sorts of plans out there.

Also, the bigger thing is if WLS is included. My company excludes it. So it doesn't matter if I have the Aetna PPO plan (which they also offer) or this other plan. I'm not getting it covered either way.

We also offer Kaiser which is an HMO and it's also excluded with that. So I don't think CA requires HMOs to cover WLS or we'd have it covered in our Kaiser plan.

My company offered about 4 different options for health insurance both PPOs and HMOs, from 2 different companies.   When it came time for open enrollment I called both companies and asked the customer service rep if WLS was included in my policy, the guidelines for approval, and which procedures were covered. 
I ended up with Pacificare, hated them...I switched as soon as the the year was over....but they covered my surgery. 
Be kind, be polite, but be persistant and if the person you are talking to says they don't know how to help you....ask them to escalate your call to a supervisor.  You can also get help from your HR department.
Good Luck!

I dont know about other insurance plans but mine is Bluecross PPO and I was approved within two weeks. I have a BMI of 41 and an illness from being over weight so that might have been why it was approved.

PPO is without question the wya to go !!!  With a HMO EVERYTHING has to be preapproved not only by the insurance carrier but also the IPAor medical group. They can deny a procedure or referral if they don't want to pay for it. I fought my HMO/IPA for over a year to get a referral adn approval. My IPA didn't refer to the surgeon I wanted even though they can and the carrier(BCBS) has that Dr as an in network surgeon and hospital. Because they referred to a different bariatric Dr they would ONLY send me there even though that DR didn't do the VSG which I KNEW was the only option for me. 
 Luckily I got a great job who offered a PPO also through BCBS. Called the Dr did the last few tests I needed adn was approved in 9 days from submittal by Drs office. What took over a year with my HMO/IPA took 9 days with my PPO and I got the DR adn surgery I wanted. 

Thank You all very much for the Information. All of you on OH ROCK!!