#ppo insurance

[missmisnomer]

i'd like to formally rescind my lifetime membership to Being An Adult, please

[chiro19454]

Montgomery County Chiropractic Center North Wales Pa 19454 #NorthWales In-Network chiropractor for Independence Blue Cross PPO and Personal Choice PPO health insurance plans IBX insurance #IndependenceBlueCross #PersonalChoicePPO #ibxinsiders

[carcarrot]

slowly making progress towards teeth removal but at what cost

[rathockey]

trying to pick out a health insurance plan like

[poptartmochi]

your honor. i think my current insurance card is only intended for use in kuwait and nearby countries... 😳;

[amarisbella21]

Comparing HMO, PPO, And EPO Plans In Group Health Insurance

In the landscape of group health insurance, employers often face a myriad of options to offer their employees. Among the most common types are Health Maintenance Organization (HMO), Preferred Provider Organization (PPO), and Exclusive Provider Organization (EPO) plans. Each of these options has distinct features, advantages, and drawbacks, making it essential for employers to understand their differences to choose the right plan for their workforce.

Health Maintenance Organization (HMO)

HMO plans are characterized by their focus on providing coordinated and comprehensive care through a network of designated providers. Members must select a primary care physician (PCP) who serves as their main point of contact for medical care. Referrals from the PCP are generally required to see specialists.

Advantages:

Cost-Effective: HMO plans usually offer lower premiums and out-of-pocket costs compared to other plans, making them an attractive option for employers looking to minimize expenses.

Coordinated Care: The requirement for a PCP ensures that all healthcare services are well-coordinated, which can lead to improved health outcomes for members.

Preferred Provider Organization (PPO)

PPO plans offer more flexibility in choosing healthcare providers compared to HMO plans. Members can see any doctor or specialist without a referral, although they will pay less if they use providers within the PPO network.

Advantages:

Greater Flexibility: Members can access a broader range of providers, including specialists, without needing referrals. This is especially beneficial for those who require specialized care.

Out-of-Network Coverage: PPOs generally offer partial coverage for out-of-network services, allowing members to seek care from a wider array of providers.

Exclusive Provider Organization (EPO)

EPO plans share characteristics with both HMO and PPO models. Like HMOs, EPOs require members to use a specific network of providers for their healthcare services, but they also offer more flexibility than HMOs since they do not require referrals for specialist care.

Advantages:

No Referral Requirement: Members can see specialists without needing a referral, simplifying the process of accessing care.

Lower Premiums: EPO plans typically feature lower premiums than PPOs, making them cost-effective options for employers.

Conclusion

When selecting a group insurance plan, employers must consider the specific needs and preferences of their workforce. HMO plans are cost-effective and promote coordinated care, making them suitable for employees who prefer a structured approach to healthcare. PPO plans offer flexibility and wider provider access but come at a higher cost. EPO plans to strike a balance between the two, providing some flexibility without the need for referrals while still maintaining a limited provider network. By understanding the differences among these plan types, employers can make informed decisions that enhance employee satisfaction and health outcomes.

[nancykhemchandani]

Choose the Perfect Health Plan | HMOs, PPOs, HDHPs

Understand health plans easily - HMOs save, PPOs give choices, HDHPs cost less. Find your fit. Your health, your plan. Ask us anything!

[facts1590]

Choose the Perfect Health Plan | HMOs, PPOs, HDHPs

Understand health plans easily - HMOs save, PPOs give choices, HDHPs cost less. Find your fit. Your health, your plan. Ask us anything!

[smartinsuranceagents]

Flexible Transitional Health Coverage by Short-Term Insurance Plans

Discover the benefits of short-term health insurance plans offered by smart insurance agents. Our plans are designed to be flexible and cost-effective, catering to your changing lifestyle. Whether you're in between jobs or awaiting long-term coverage with essential benefits to ensure your protection, visit our website for more information.

[ptlsalp]

Insurance: Details about Marketplace plans that were available to me

Based on notes I took while deciding on my new insurance plan, here are some limited details about Marketplace plans that were available to me in the state of Michigan. You may or may not have the same plans available.

Blue Cross Blue Shield PPO

-- Purchase decision: ✅ -- Certificate of Coverage published: ✅ -- -- No stated "one per lifetime" limitation on sterilization: ✅ -- -- Coverage for treatment of complications related to non-covered services: Doesn't exclude coverage: ✅ -- No referral to see specialist: ✅ -- Key providers and facilities in-network: ✅ -- Available plans: Secure, Extra, HSA -- Reject reason: None

Blue Care Network HMO

-- Purchase decision: ❌ -- Certificate of Coverage published: ✅ -- -- No stated "one per lifetime" limitation on sterilization: ✅ -- -- Coverage for treatment of complications related to non-covered services: Doesn't exclude coverage: ✅ -- No referral to see specialist: ❌ -- Key providers and facilities in-network: ✅ -- Available plans: Select, Preferred, Local, Metro Detroit; some of these weren't available in my region -- Reject reason: Need referral to see specialist

UnitedHealthcare HMO

-- Purchase decision: ❌ -- Certificate of Coverage published: ✅ -- -- No stated "one per lifetime" limitation on sterilization: ✅ -- -- Coverage for treatment of complications related to non-covered services: Explicitly includes coverage: ✅✅ -- No referral to see specialist: ❌ -- Key providers and facilities in-network: ❌ -- Reject reason: Need referral to see specialist; Key providers and facilities out-of-network, with smaller network overall

Molina Marketplace HMO

-- Purchase decision: ❌ -- Certificate of Coverage published: ✅ -- -- No stated "one per lifetime" limitation on sterilization: ✅ -- -- Coverage for treatment of complications related to non-covered services: Explicitly includes coverage: ✅✅ -- No referral to see specialist: ✅ -- Key providers and facilities in-network: ❌ -- Reject reason: Key providers and facilities out-of-network

MyPriority Health HMO

-- Purchase decision: ❌ -- Certificate of Coverage published: ❌ -- No referral to see specialist: ✅ -- Key providers and facilities in-network: ✅ -- Reject reason: Certificate of Coverage not published

McLaren HMO

-- Purchase decision: ❌ -- Certificate of Coverage published: ❌ -- No referral to see specialist: ✅ -- Key providers and facilities in-network: ✅ -- Reject reason: Certificate of Coverage not published

[captorcorp]

ough the pain of finally getting around to calling a dentist and then waffling on the phone for half an hour bc you forgot they needed insurance info and the online portal/digital card for your dental insurance sucks shit for finding information

[chiro19454]

Montgomery County Chiropractic Center North Wales Pa 19454 #NorthWales In-Network chiropractor for Independence Blue Cross PPO and Personal Choice PPO health insurance plans IBX insurance #IndependenceBlueCross #PersonalChoicePPO #IBX

[health-insurance-struggles]

Types of Health Plans

This post is going to suck to read. I know it will, because it sucks to write it because it’s boring.

Time to put on your big kid pants, because it’s important.

Let’s talk about the three major types of plans and three major types of healthcare accounts, and the talking points of each.

Preferred Provider Organization (PPO) - A general health insurance plan, and (in my experience) the most common. You can go wherever you want for healthcare, but you’ll pay less if you stay within the preferred provider list (a fancy way of saying in-network providers). You don’t need a PCP to refer you to a specialist.

Exclusive Provider Organization (EPO) - You only have coverage for in-network providers. You have no out-of-network coverage, except for emergencies. You don’t need a PCP to refer you to a specialist.

Health Maintenance Organization (HMO) - A very specific insurance policy that covers only certain healthcare provider systems (think hospital systems across a large metroplex). It is usually cheaper, but your choice is significantly more limited. You will need a PCP to refer you to a specialist, and you’ll need special permission from your insurance for an out-of-network provider to be covered.

Fun, right? Not confusing at all. It gets better! There are also healthcare accounts that your policies can offer. Let’s talk more about them.

Health Savings Account (HSA) - Pre-taxed money lets you pay for medical expenses (that qualify). You can invest money into the HSA and it rolls over every year to any employer. Basically, the funds never go away—new employer, new policy, and retirement don’t affect your HSA. This is usually associated with a high deductible, lower premium plan.

Flexible Spending Account (FSA) - This is associated with more traditional health plans. It’s also pre-taxed money, but it expires at the end of the year. Both you and your employer contribute to the fund, but anything you don’t use goes back to the employer, not you. The money doesn’t roll over each year or accumulate between employers. There are FSA plans all over the map in terms of deductibles/premiums, so it’s hard to generalize which one it’s associated with the most.

Health Reimbursement Account (HRA) - I’m going to be honest, I don’t know as much about this one because I personally haven’t worked with one. From what I know, it’s an employer-owned and funded account to help members bridge the gap on their health insurance. You can usually use it to pay copays, deductibles, and coinsurance. This doesn’t roll over and you don’t carry it with you, but your employer is the only one who pays into it.

Confused? Yep.

So how do you pick one? Well. I can't tell you, because it's up to you. But in my opinion...

I have a lot of health problems, so I want the largest network possible. I don't want to try to make a PCP appointment every time I need to see my specialist(s). I'm young and I don't plan on staying at the same employer forever. I'd pick a PPO HSA plan, because of the flexibility of the provider network and the rollover of the account. This will probably be a more expensive premium each month, but for me, it's worth it.

Maybe you're in excellent health. You've worked at your company for decades and have no plans of leaving, and you go to your annual check-up and that's it. Great! Maybe you are fine with an EPO or HMO plan and an FSA. Those could be cheaper premiums.

It's up to you. It depends on your needs and your spending preferences.

[thedisablednaturalist]

I found a great provider that does a ton of integrative care and even does aquatic therapy (its the ONLY place in the area that has an aquatic treadmill) and its all in one building right near my apartment. The only issue is it costs $300-500 per appointment as they are out of network with all insurance companies and I have an HMO plan. I was hoping I could just go there for physical therapy but that's still like $300 per appointment.

Apparently I can petition for a gap exemption since literally no other place has aquatic therapy in my area? but it can be a bitch to get your insurance to approve it

I'm now looking into patient advocacy groups to help with getting me the care I need because at this point I'm fed up with the search. I'm tired of being constantly referred to scam holistic centers and told theres nothing they can do for my pain now pay us $50 dollars. Apparently Myofascial Release Therapy and aquatic therapy would do great for my pain but there's no place that takes insurance that does that.

I found a patient advocacy center but it costs $150 an hour so what's even the point. There is one that is free but its for people with "serious chronic conditions" and idk if they'd consider my chronic pain and spine stuff serious enough.

Im just so tired and i dont have the spoons to do this on my own anymore. I'm paying hundreds a month on insurance but can't get the care I need since its too specialized/out there or theres no specialists near me in network. I thought I picked a PPO plan but apparently not. All this stuff is so confusing and complex and I don't have the mental energy to deal with it all. And you can't ask insurance for advice because they will give you bad advice! bc they dont want to pay for shit!!

I just want to live and stop getting fucked over. I'm tired of the 15 minute appointments that don't do anything for me. That are just so I can get refills of medication. That dont explain everything or look at all my records or listen to me.

Has anyone used a patient advocate outside of a hospital before?

[intersex-support]

hello! i display a lot of the symptoms of having trisomy x and would like to find out for sure if i'm intersex or not, but afaik the only way to know for sure is to get a karyotype and i'm terrified of the medical discrimination i might face as a result of doctors knowing i'm intersex. is there any other way for me to find out but still have my doctor not know? or am i just overreacting (especially since most other intersex people don't get the choice of finding out or not)?

Hi anon!

I think it's totally understandable that you have a lot of fear about trying to navigate the medical system as a potentially intersex person. It can be really difficult to have to deal with the amount of discrimination we face when we're seeking a diagnosis and existing as an intersex person in the medical system. It's fucked up that we have to think through all these things when we're seeking care, instead of just being able to trust that we would receive compassionate and respectful care that honored our autonomy.

Unfortunately, I don't think there is any way for you to confirm a Trisomy X diagnosis without getting a karyotype/chromosomal microarray, just because there really is no other way to confirm what chromosomes you have. However, I think there are some ways that you could navigate it that might make it a little easier to avoid some kinds of discrimination.

This information is all based on the US healthcare and insurance system because that's what I have direct experience with, but feel free to send another ask if you live somewhere else and we can brainstorm some ideas for your health system.

My first thought is that if you want a diagnosis but don't want to impact the rest of the medical care you receive, you might be able to see a separate genetic counselor that's not linked to the rest of your medical record and medical care. There are a lot of services that do telehealth genetic counseling such as Genome Medical, and if they take your insurance, you might be able to get testing set up through them but not have it show up on the rest of your medical record. The nice thing about this is that you only have to deal with the telehealth clinician a few times and then get to choose whether or not you want to disclose this information to any future providers you see, and you don't need to have this information in your medical record if you don't want to.

If that's not an option but you have a PPO or POS health insurance plan where you can see any preferred network providers without referrals, you might be able to go to a separate genetic counselor that is part of a different hospital or clinic than where you normally receive care.

If your health insurance is an HMO plan where you have to get PCP referrals and can only see in network providers, that might make it difficult to seek care that isn't linked to your medical record. If this is the case but you're still interested in seeking a diagnosis, it might be worth brainstorming some things that would make you feel safer through the process. This could look like bringing another supportive person with you who could help advocate for you, preparing scripts for how you want to advocate for yourself, seeking out information about your rights as a patient, asking other intersex people for doctor recommendations, bringing in the "What we wish our doctors knew" brochure from InterACT. I won't lie, having an intersex variation on your medical record can make seeking medical care more complicated, but I think it can be slightly easier to navigate when you're a teen or adult who has more autonomy over their care, can consent to things, switch providers more easily, and has more of a say in their care.

If any followers have any other innovative ideas about how to seek diagnosis, feel free to add on.

Ultimately, the choice about whether to seek a diagnosis or not is always up to you. You're the expert on your own experience and know what would feel right for you at this point in your life. I don't think you're overreacting or being silly, and I wish things were different and it was easier for you to seek a diagnosis.

Truly wishing you the best of luck, anon.

[butch-reidentified]

i do like that person that was like "x is often self diagnosed/misdiagnosed so it's fine for doctors to instantly dismiss or belittle you!" Its like. No actually, a doctors duty of care is that they need to take it seriously & rule it out anyway? If there was a spate of prank calls to 911 about fires would the operator be forgiven for laughing in the face of someone who's house is actually burning down?? No tha fuck not! But ofc this doesnt even apply to you since it was before pots was commonly known etc etc. i just thought it was funny that even if the premise anon set was true to begin with it would still certainly not be ok lmao.

prev anon

exactlyy

if anon does work in medicine I hope someone reports them. the mentality of instantly dismissing people (read: women [esp since POTS and EDS primarily affect women btw]) is sick

in fact, people with EDS call themselves Zebras because of the whole "when you hear hoofbeats think horses not zebras" but we are what happens when it is actually zebras. doubling the irony of anon's insane "contribution"

I have never known a medical professional who doesn't take POTS seriously *at all* either, and it was very clear that anon doesn't actually know fuckall about POTS (or MCAS or related conditions for that matter, despite alluding to them). like I said to anon, POTS cannot be faked like that. especially long-term. my heart rate went from mid-70s sitting to 170s standing. good luck faking that fr. especially /every single time you ever stand up/ (like any fitness watch can show you is happening)

I had a bunch of tests done to get my diagnosis, and then had to see multiple cardiologists post-dx in order to even begin to get an attempt at treatment. the first treatment the final cardiologist tried made me BEDBOUND for FIFTEEN MONTHS. in college!!! I was using a cane through half of college. POTS is not a joke and doesn't fuck around.

my life changed once I found ivabradine (corlanor), but that took quite a while. and even then it took me YEARS to get a real prescription (during which time I relied on free samples from a saintly doctor) because only the brand name Corlanor was available in the USA until literally a couple of months ago, and most insurances wouldn't cover it for POTS because it's for heart failure so it's an off label use. and brand name Corlanor is EXTREMELY expensive. and I qualified for Amgen's financial assistance program and got rejected anyway, btw. I have to take such a high dose that I need two prescriptions of it a month, which costs ~$1300. I had to switch jobs to get on an insurance plan that was willing to cover it for POTS (after a huge fight). when I had to leave that job, I had to start buying the market version of that (gold tier PPO) insurance for $1000/month because that was still cheaper than the medication.

you can't even comprehend how much money I've spent over the past decade to be remotely functional POTS-wise, and again, I consider myself VERY lucky. I have something that works. even though I frequently have gaps in my access to it, even though I have to constantly fight with doctors, insurance, and pharmacies to maintain it. despite the insane expenses. I am very very lucky POTS-wise. I have seen what unlucky looks like.

vEDS & the 24/7 chronic pain is a whole other beast, as are the associated extensive and debilitating issues like GI problems and migraines.

I don't talk about this stuff a lot on here, because I don't see any point to it. it's just gonna depress people. but that anon was appallingly ignorant and spreading misinformation. anyone who has insight into the real lives of people with POTS, EDS, MCAS, gastroparesis, etc., would understand how horrific these are to deal with, not just on their own, but in terms of things like living life (working a job, social life, etc) and dealing with the US healthcare system as well. not to mention that vEDS likely cuts my lifespan in half.

it's legitimately SO infuriating and disheartening to have watched in real time as POTS & EDS went from "nobody even knows what these are so good fucking luck getting medical help" to "increasing awareness and POTS getting changed from rare to common on google" to "this is just something for tiktok fakers" in 0.5 seconds flat

tldr -- that anon should actually die. or try living a single day in my body. one of these is easier than the other.