Posted by jane d on June 4, 2004, at 22:37:41
In reply to Seeking advice re: insurance, posted by Racer on June 4, 2004, at 11:33:35
I swore off HMO's after I had a ridiculously long wait to be seen on a fairly urgent matter. With my PPO when I think I've waited enough weeks or months I can just go to a non preferred provider and pay a bit more (strange how there seems to be less delay this way). The PPO also lets me keep a few doctors I like who are not on my current insurance plan. This ends up costing more though, so if the money absolutely isn't there it's silly to pay higher premiums for a feature you can't use.
Your mileage may vary disclaimer time: Insurance (with the exception below) is regulated by state law. Your state has different rules from mine. And even with in the same state, the same insurance company will offer plans with slightly different terms. Check the terms of yours with the employer. And no, it is definately not fun to call up human resources to ask whether or not they will pay for your psych care. Well..... I guess it COULD be fun.
Beware. The PPO's I've dealt with can also have limits on mental health and often do. They may limit the total number of visits in a year to 20 or 30 but leave it totally up to you how you use them or they may also require you to get preapproval from one of their cost cutting CSRs. Probably the same one they use for the HMO. Definately something to check in advance.
I never did try to get mental health care when I had an HMO. Basically I was #(*@#@#A if I was going to call up to get permission from a gatekeeper. And at the time I needed the help I probably wouldn't have been able to navigate that system either. I've been following your posts and you seem to be a far more effective advocate for yourself and might be able to make it work.
The other problem with HMO's that I've heard of from other people is that they had major problems finding someone who was actually in the HMO's plan. Lots of entries in the HMO directory were long since departed for more prosperous pastures or weren't taking in any more patients. If there's no one acceptable in your area who is actually in the plan (as confirmed by the provider of course) then your decision just became really easy.
One last thing to keep in mind. So far there is no federal mental health parity legislation requiring insurance companies to give the same benefits for mental health. Some states do have have parity legislation - I think yours may be one - but employers who self insure are not bound by the state rules. These are companies that are taking the financial risk themselves and just using an insurance company to do the management and it's something that only the big guys are going to do.
I wish I could be more help. Good luck.
Jane
poster:jane d
thread:353743
URL: http://www.dr-bob.org/babble/social/20040602/msgs/353933.html