Question:
Should I go with the Blue Cross HMO, or the PPO?

Yeah, yeah I now you people are all sick of me ;-), but I do need your help again. Seems my paperwork is due tomorrow :P! And I only have half a brain today, darn flu! I am not sure if i should go with the HMO, or the PPO plan. Lemme go grab both paperwork packets, so I can do a list... ------------------------------------------------------------ HMO: ------------------------------------------------------------ 1. NO DEDUCTIABLES!! 2. Will have to pay only co-payments for surgery! 3. Will have to find new surgeon. 4. Will have to get a new Dr. 5. Must start process all over again. 6. Benefits area states: (exclusion) to weight loss. Services, programs, or supplies for losing weight or the treatment of obesity. We will cover this kind of care if we find that the member is morbidly obese. 7. Says it is: CaliforniaCare plan 8. Open enrollment again in Jan 2003. ------------------------------------------------------------ PPO: ------------------------------------------------------------ 1. Will have to start again with my $250 deductiable! 2. Will have to pay $2,000 total for surgery 3. Can keep dr. (am glad about this) 4. Can keep surgeon (not crying over losing him) 5. Process stays where it left off with Pac Care. 6. On benefits it says (exclusion) Obesity. Services primarily for weight reduction or the treatment of obesity. This exclsuion does not apply to surgical treatment of morbid obesity, as determined, and if the treatment is authorized in advance as medically necessary and appropriate. 7. Says it is: Prudent Buyer Plan 8. Open enrollment again in Jan 2003. ------------------------------------------------------------ If anyone can provide any help at all I would really apprecihate it! Post here, email me, whatever! I am going to try and call them later today as well to see what they suggest. Thanks gang!    — Heather H. (posted on February 21, 2002)

February 21, 2002
Heather: I just finished reading your profile. Dr. LaMar assisted on my surgery along with Dr. Pehrsson in Dec. I had Blue Cross PPO, Prudent Buyer Plan and had NO problems whatsoever when it came to approval. With my co-pays and psych. eval. my out-of-pocket expenses were $56.60. If you have any questions, check out my pre-op posts and if you don't find what you are looking for, email me. http://home.earthlink.net/~tmrivas
   — tmrivas

February 21, 2002
Absolutely, without a doubt go the PPO route, much less hassles, not just with this but with all Dr.'s visits. Much more freedom of choice. Your deductible savings will fade in importance if your stuck with a plan you hate- a likely scenario with HMO.
   — [Anonymous]

February 21, 2002
I have BC/BS HMO. We switched my husband's plan over a year ago when we realized that all of the doctor's that we used were on both plans and the HMO cost a fraction of what the PPO cost per payweek. I was a bit nervous about being approved with the HMO, but with no serious comorbidities, I was approved in 4 days, no questions asked. I have a $25 co-pay for specialists, so between my two preop visits and my Upper GI, I put out a total of $75.00 for my surgery. My husband has less than $8.00 deducted from his check each week for the HMO, so I consider this a real bargain. The only hassle was remembering to get the referrals which wasn't a big deal. Good luck to you.
   — Donna L.

February 21, 2002
Definitely go with the PPO. HMO's have too many exclusions and rules to follow. I have Blue Cross PPO. My total out of pocket for LAP RNY was $808.
   — Wendy H.

February 21, 2002
Like the ole saying "A bird in the hand is worth two in the bush". If everything is set with the PPO, then I'd stay with them! I have an HMO (Blue Choice Option) and I went through nine months of hell getting approval. Everytime someone said yes, they wanted me to see someone else. Evidentlly hoping they would say no. I HATE HMO's! I'm not the best reader, but it sounded like everything was all set and approved with the PPO. I'm not sure why you are even considering changing? But as I said, my reading skills are crapo. Man I would'nt even consider upsetting the apple cart now. ;) Good luck with whatever you decide.
   — Danmark

February 22, 2002
I have BCBS of Illinois PPO. I was just approved for the BPD/DS. I don't know which group carries your policy. Mine stated that the procedure had to be predetermined, meaning it had to go to review board. My dr sent 50 pages. Once the paperwork was received (Friday) I was approved on Tuesday. Good luck.
   — Joy B.

February 22, 2002
I have a PPO and only paid 100 out of pocket for the surgery. If you don't have to start all over, it will be well worth the deductible payment.
   — Stephanie N.

February 22, 2002
Heather..best of luck on your journey.. I had the same dilemma...decided to keep doc and PPO. Be warned....Approval with ppo may not travel to hmo...they told me that I might have to restart the whole process and may not get approved. ( even though they were both BCBS!!!) FWIW, Make a few calls. I was told that if I had already started the surgery process, that the hmo would NOT pick it up. Again, take it with a grain of salt, this was just my personal experience. My out of pocket is $7800 ppo. ( My docs are not in any network) I was very lucky to be able to even make that choice. Your experience may differ. Follow your heart! Take care and keep in touch! Michelle P
   — Michelle P.