Choosing your health insurance benefit

Nurses General Nursing

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Hi all, I finally found a new job. I am very excited, I will be working as a case manager for an insurance company.

Anyway, I have narrowed down the choices for my health insurance to two: The PPO vs the HMO

I have never ever selected the HMO option before b/c I never wanted to deal w the hassle of referrals. BUT, the HMO is FREE to me & my family. The PPO w vision and dental inculded will be a grand total of 68.50 deduction from each paycheck, which is still not bad considering my husband is currently having 98.00 per paycheck.

So, for those of you who have HMO's, is it that awful to get referrals? My kids see the dermatologist regularly, and I have never had to worry about dragging along the paperwork.

All my docs are on the plan, except the hospital I prefer is not on the PPO or the HMO, but also not on hubby's, so all surgery would have to be at the yucky hospital, or I guess I could go out of my county??

Otherwise the plans are very similar, in fact, the HMO covers 100% whereas the PPO covers only 70% of many procedures. The drug co-pay is slightly higher for my BP med, but still way cheaper than a bi-weekly payroll deduction. And cheaper still if I use the mail in option, which is a three month supply for the same amount as the pharmacy.

So, for those of you who have HMO plans, is it do-able or is it the worst hassle and not worth saving the 68.50? Our budget is kinda limited right now, so if I could save some money this way, I really want to try it, but by nature I am NOT a gambler, and the last thing I want to gamble on is my family's health.

Help me to choose!! Thanks! :kiss

Specializes in obstetrics(high risk antepartum, L/D,etc.

My only comment is this. Having worked insurance claims, and gotten the referrals and pre authorizations from the MD offices, if you want a GED wanna-be directing your health care, go HMO. With PPO, you have a lot more leeway and control of your own care. :p

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