HMO Update

[sues1953]

Hi all,

I have been doing nothing but research I told my daughter that I could probably remove this sucker myself by now.  That said, back to the drawing board.

I talked to Dr. Slattery at House last week and have been persuing ins coverage with my HMO.  I talked to Rita and she was soooo nice.  I faxed her my ins. info and she called my insurance company and was very encouaged that they did not say no right off the bat ( I do not have out of network coverage).  she told me that she was sending a letter to my primary care DR.  and that he was a very important part of this.  I called his office to give him a heads up and it took him a week to call me back.  He had not seen the letter although he told me that didn't mean that it wasn't there.  He told me that because there are Dr. here that want to do the same procedure (Translab) it would be very hard to get my ins to pay House.

While I was waiting for my DR to call me I started really researching SBI.  My primary care Doc told me that I have a much better chance to get out of network coverage for that being they will try to save my hearing.

I talked to Roxy (House) and she wants a letter from my DR and that is now in the works.  She told me that they do work with HMO's and that they would be able to tell me in advance what my part would be (750.00 consult fee included)  I live in MI and lost my job this past summer and my husbands business is auto related and we are financially sinking fast.  I just have to think about my best option for surgery and recovery.  Any input would be welcome.  Sue

[leapyrtwins]

Sue -

my honest opinion.

AN surgery is very expensive.  If cost is an issue for you - as it would be for most of us - and your insurance won't cover going out of state, there are some great doctors in Michigan.

As far as SBI, no one can guarantee they can save your hearing - or make any other guarantees about your post op "condition" - so please proceed with caution.  While it's great to be optimistic, don't believe in anything 100%.  As they say, man planned, God laughed.

Just my two cents, for what it's worth.

Best,

Jan

[sues1953]

Thanks Jan I always appreciate your input.

I have so much more information I thought I would update this thread for anyone with HMO insurance that might be looking for out of network coverage.

If you have a group insurance you may be able to change to a PPO which will cover out of network.  You will have to wait until open enrollment but preexisting condition will not be an issue at all.  Also the premiums you will pay will be higher for the PPO but worth it.

This is great information for people in watch and wait mode.

Sue in Michigan

[ppearl214]

Hey Sue,

I know you have been through the wringer on trying to get your Insurance worked out.

In your note above..... please know that yes, PPO will cover "out of network" but at a much higher cost that "in network".  I know the choice between HMO and PPO can be tough... as HMO is less money/month for insurance premiums... and works great for those not needing a lot of medical attention. For PPO (I am on PPO), it is a higher monthly premium cost than HMO.. but I am still limited on "in network" vs "Out of network".  If I stay in network, I get this and that covered at much lower "out of pocket" costs/deductibles, yet, I am battling some "out of network" expenses now on my PPO... and it does add up.

I'm sure the surgery, via PPO "out of network" may be less than what you are being quoted, but be very careful on your insurance homework.....since your open enrollment is Oct 1 (based on the info in your other post/thread), ask your employer now about "PPO" and have them give you (if they can, this early) what the PPO allows, in % or $, for out of network coverages, esp for the extensive hospital bills for the AN surgery (ie: surgeon, in patient, drugs, scans, PT, etc). There may be a lot of ancillary to be affiliated with the surgical procedure.

Just my opinion... proceed with caution and please do you extensive homework on this one.  I don't want you to get "bit" by hidden costs that can creep up on you. I have been bitten by the "out of network" bugger too much... and I'm still paying bills.

Just my 2 cents.
Phyl

[sues1953]

Thanks Phyl,

I will check the details on the PPO.  The wind has been taken out of my sails.  I just came down with the flu (yes the throwing up kind).  .  I really really wanted this to work out despite the wait but your absolutely right I do have to know every detail so there are no surprises.

Thanks to all of you who have warned me. 

Sue in Michigan