Question:
Do I have a better chance of approval with PPO than HMO?

   — Elizabeth C. (posted on January 23, 2002)

January 23, 2002
It really isn't whether you have an HMO or PPO that matters. What matters is what the policy covers. If you have an HMO, you must go to in-network providers in order to receive benefits. With a PPO you can use out of network providers, but you usually have higher deductibles and pay a higher percentage of the cost. It's possible to have both offered through the same insurance company and have the policies be the same.
   — [Anonymous]

January 23, 2002
The cool thing about having a PPO is that you don't have to get a referral to see a surgeon. If you have an HMO, you usually have to get a referral from your PCP to see a surgeon and then you can start the process. It also, in my opinion, limits the doctors you can go to since your PCP has to refer. With a PPO, you can choose a network provider and your PPO may (you have to check) pay for 100%. If you choose an out-of-network provider your PPO may kick in a little and the rest is up to you. Good luck! Contact me if you have any questions. http://home.earthlink.net/~tmrivas
   — tmrivas

January 23, 2002
Elizabeth, I have an HMO (Horizon BC/BS). I worried that it would be hard to get approved. But it wasn't at all. I got my approval 4 days after the paperwork was sent in. And that was with no serious co-morbidities, just some family history of heart disease and diabetes. The referrals from my pcp were kind of a hassle, but nothing too inconvenient. I'm lucky that my pcp was very supportive of my having this surgery. All I had to spend were co-pays for my pre-op appointments. Don't even need to do that with the post-op check ups! Like a previous poster wrote...its whats in the policy that matters, not so much the type of policy. Good luck!
   — Donna L.

January 24, 2002
I have Aetna HMO and was approved in 24 hours. And I only paid $240.00
   — Cindee A.