Question:
Should I pay extra and switch to PPO?

Hi! I am not quite half way through the HMO process to be approved for WLS. It has taken a long time to get to this point. I've gotten most of the screening tests, except the psych eval (I go next month) and I haven't even gotten to see see the FIRST doctor for a screening consult. On top of that, I'm forced to go to a program that's not near my home, extremely busy, and definately not my first choice. I still probably have about 6 months to go before surgery. Well YEAH, my husband got a job with the state and we have the option to get the Cal PERS PPO (which is administered by BC/BS). The monthly cost to have us both covered would be $140 (our part of the premium). I would do it in a second, but the policy has a WLS exclusion, which reportedly does NOT apply to MO, but it does not specifically say that. Now I can't decide if I should switch. Depending on how things go, I could have my surgery in a few months. Then again, if I stick to my HMO, it might be a few months plus a few. There is also the risk that the new PPO does not pay, and of course at the very least, I'll at least have to pay a much higher copay than HMO. Well and there is the risk that the HMO won't approve me either (although they better, I've played their game so far!!). If you have any advice or thoughts, I'd appreciate it!    — w8free (posted on April 9, 2003)

April 8, 2003
Elizabeth - I had the same questions when I started my journey. I started off with BC/BS, HMO and I ended up "upgraded" to BC/BS, PPO. I was told by my surgeons coordinator that the PPO was "Slightly" better than the PPO. Both policies excluded WLS unless it was medically necessary--Two days ago, BC/BS approved me (within 3 days of receiving my paperwork). Another person with BC/BS, HMO had the very same thing happen a month prior. >^,,^< Kim
   — Kim W.

April 9, 2003
Elizabeth, I have Cigna PPO and discovered that they have an exclusionary clause, so switched to my husband's BS HMO. It took 6 mos. from the time BS got into it until I had my surgery. After you get your psyh eval and see the surgeon, it will take no time at all before you are on this side. I only paid $200.00 out of pocket using the HMO. I have spoken to other people about this issue and discovered the the HMO covers better than the PPO.
   — Gloria P.

April 14, 2003
Elizabeth, sometimes a switch to a PPO might prove to be costly, yet it could also be very beneficial as it was for me. I personally don't like anyone telling me what doctors I can or cannot go to. I didn't particularly like having restrictions placed on who I could see. Now, I pay about $300 per month for BCBS-Federal PPO Standard Option (was formerly called High Option) It really hurt my pocketbook, but it was QUITE helpful in the long run. I had a hospital bill of over $34,000 for my WLS and my doctor's bill was about $7,000. All but $300 was paid by my BCBS, and I rec'd a bill from my surgeon and I SOL (screamed out loud) when all I had to pay was $1,500...and that was because I went out-of-network in selecting the surgeon I did. It's a matter of personal preference and if you think your surgeon or the one you want is worth it, and you're prepared to "pay the cost", then I say, GO for it! Hope this helps!
   — yourdivaness