ARGH!

[Pooter]

Is there any more ineptitude than insurance companies?  I specifically signed up for HMO with our new company because it will be lower out of pocket than PPO with the known follow-up appointments etc..  Well, I find out from the insurance company today that I have PPO coverage.  Now, keep in mind that I have my follow up appointment with my surgeon exactly a week from today.  I was already cutting it close and their ineptitude isn't helping.

What a mess...  Sorry, for venting..   

Brian

[leapyrtwins]

Pooter -

don't you just hate mix ups like this   And the timing is very "sucky" also    Extremely frustrating, to say the least!!!

I'm assuming there is a form you completed for the HMO sign up so I'm hopeful they can correct their mistake ASAP.

Keeping my fingers crossed on your behalf 

Jan

[Pooter]

Jan, thanks for the concern.  I clearly checked "HMO" on my form so hopefully our benefits brokerage company (that we did all this thru) will be able to fix it tomorrow.  Just what I wanted to spend my morning doing tomorrow.  It is frustrating.  I had the owner's wife (who's over benefits) trade emails with me and ultimately a phone call because she couldn't understand why I don't just stay with the PPO and go with HMO instead.  Something about a high deductible and a percentage that I'm on the hook for between now and Dec 31 and then again starting in January that just doesn't jive with me KNOWING that I will have dr visits and MRI's, etc..  I finally convinced her that it makes more sense for me financially to be on the HMO.  Heck, if I didn't have the choice, that would be one thing, but don't offer it if it's not available to me.    I want my HMO darnit!  With the exception of about $1,200 that I paid, my $100,000 cost me a fraction of that with the HMO but I would have paid MUCH more than that with the PPO.  It just makes more sense given the known and the unknown.

Thanks again!

Brian

[wendysig]

Hi Brian,
I feel your frustration!  Sometimes people just don't see these things as a big deal when it doesn't affect them  Insurance companiy reps seem to work from a script a lot of the time in my experience and it can take a lot to get through to them.  I hope you get this worked out before your appointment.

Wendy

[Jim Scott]

Brian:

Argh!, indeed.  You certainly have my sympathy on this issue.  I've been there.  Fortunately, my wife, a former insurance claims supervisor for a large insurance company (home & auto, not medical) has the knowledge and experience needed and handles most of our insurance business.  She's had numerous runarounds with the company, often over her bills, not mine.  However, early this year, as I was about to turn 65, she had 3 different phone representatives swear to her that I could continue my coverage under her policy, so I turned down Part B of Medicare.  After I submitted a bill, the company only paid 20%.  When we complained, they said that because I qualified for Medicare Part B, they would now only pay 20% on my medical bills on the basis that I already had Medicare 'B' coverage.  If I chose not to take it, that was my problem because it's an 'entitlement'.  My wife, a normally sanguine individual, went ballistic and complained to the company that this wasn't what she was told by company reps.  She was astute enough (from experience) to get their names, making it hard for another company employee to deny this was ever said.  She reiterated that the 3 representatives in Customer Service (a misnomer, for sure) had all assured her I would be fully covered under her policy, as always - no problem.  She wouldn't be put off and finally got through to a manager who reluctantly admitted that the company reps had screwed it up.  She agreed to authorize full payment of my medical bills until the end of the year.  So far, this has worked out as planned.  I'm applying for Medicare part B this week, to begin in January. 

So, Brian, when I say that I sympathize with your frustrations, I'm not just being polite, I speak from experience. 

Jim

[Pooter]

Thanks Wendy, Jim and Jan.  I knew I could vent to you guys and you'd understand my frustration!

I'm told now that our benefits broker is "waiting for rates" for the new HMO.  They had quoted us based on a certain number of people being on HMO but since (gosh) everyone's on PPO and I'm the only one complaining to be on the HMO they have to re-get the rates.  I'm no rocket scientist (heck, I didn't even sleep at a Holiday Inn Express last night), but it seems that she would be able to get those rates in... conservatively, a day.  It's now been 3 days and she's still "waiting" (knowing my appointment is next Tuesday and I still need the referral done).  Talk about watching paint dry!

Everyone's on stand-by until she gets off her duff and gets it straightened out!  I sure as heck hope they don't come back with some astronomical number per month it will cost to be on the HMO in an attempt to force me into the PPO.  I fully expect that they will.  I will be one ticked off fellow if that happens.  If HMO wasn't a choice, don't give me the choice.  If it is, then do as I ask.  Is that so hard?

To her credit, the lady I talked to at BCSB was very helpful and nice.  I was setup with PPO so to her I was a PPO patient.  It's not her fault the benefits lady screwed up nor is is her mess to clean up.  I just hope I don't need to reschedule my follow-up, but it's looking that way more and more.  *sigh*

Anyhow, thanks for letting me vent. 

Regards,
Brian

[Debbi]

Arrgg indeed, Brian-

I can feel my blood pressure going up just reading your posts.  I hope you get this sorted out asap - you certainly don't need insurance worries right now!  I secretly think that some of the people on the other end of the phones at the insurance company may be the axis of evil!

Debbi

[Pooter]

Well, I was forwarded an email sent to the owers wife (also works there, one of her jobs is benefits coordinator)..  The lady at the "benefits broker" said that "...your request that we add the HMO to your plan was denied by Underwriting...".  And, that we could "...add the HMO to the plan at renewal time".

Wait a second... Why did she have to ask permission from anyone to add me to something that should have been part of the plan the whole time, but she (or someone) screwed up and put me on the other?  I get that we're a new business and that this is a new group.  But, I was presented with options of going with PPO or HMO.  I chose HMO.  It's that simple.  Someone goofed and put me on PPO.  FIX IT!

Well, I took her address from what was forwarded to me and I wrote a pretty scathing email to her asking just that.  I haven't received a response yet.  But, I'm beginning to believe that either she or the owner's wife decided that not enough of us wanted the HMO to get it, so they put us all on the PPO (probably figuring that we wouldn't find out until it was much too late to do anything about it).  I am starting to think I never had a choice and PPO was the only option available because they wanted it that way (come to think of it, the ower's wife pushed pretty hard for everyone to join the PPO plan)..

I'm so flabbergasted by this whole thing.  Nobody seems to understand that I have my follow-up next Tuesday and that by being on a PPO plan, I will have to pay MUCH more out of pocket than if I were on the HMO plan.  I'm irritated that it at least appears that I never had the choice that I thought I had in the beginning.  Oh, did I mention that I'm making about 25-50% of what I was making with the old company?  I was there for 6 weeks.. got "paid" for 3, but my "pay" was (expectedly) about 50% of what I'm used to making.  Do the math..that works out to about 25% of what I was making before.  AND I get on a plan that I never signed on for that will end up costing me much more money out of pocket.

I'm SO frustrated right now that I could spit..

Brian

PS  In this case, I wouldn't say that the insurance company is part of the Axis of Evil, Debbi, but the owner's wife and the "benefits broker" are!  What a crock!

[yardtick]

Sorry about your health insurance problems Brian.  Now I'm going to ask a very silly question.....what is PPO?  I think I know what HMO is.  I'm Canadian and I know we have a lot of people from all over the world on this forum who maybe scratching their heads in wonder.  I just hope you get things sorted out.  You really have been through enough I'd say.

Anne Marie

[Pooter]

A PPO is a medical plan that works like this:

a) You can choose whatever doctor you want so long as they are "in network" (on the plan)
b) There is a deductible to meet for each person in your family on the plan (sometimes a "family" deductible)
c) Once you meet the deductible, the insurance will pay some percentage for the treatment (usually 80-90%)

With HMO, you have to pick a "primary care physician" that you must see first and be "referred" to see a specialist.  There is no deductible, and most normal things are covered at 100%.  There's usually a "hospital confinement fee" that must be paid if you stay in the hospital, but most everything after that fee is covered at 100% (hence why I paid about $1,200 total for my $100,000 surgery.. some was elective, like I chose to spend extra for a private room).

In my opinion, if someone KNOWS they're going to use the plan, it makes more sense to be on the HMO plan even though it is more expensive out of each check.  Anyone who KNOWS they're going to use it (like with follow-up care, MRIs, etc..) then why would you CHOOSE to pay 10-20% after a deductible? You would end up paying more money (IMO).  Who cares that you need to get a referral to see a specialist?  I've been ready to do that for 4 months, waiting on them.

They're trying to move to more of a hybrid between the two.  The deductible is lower and the % paid is typically higher (but both are there and haven't gone away) but you don't need a referral to see the doctor.  It still makes more sense to be on the HMO because you pay less out of pocket, which is why the insurance companies are trying to do away with HMO plans and make the PPO plans more attractive.

Hope this helps, Anne Marie.  Thanks for the concern...

Brian

[Kaybo]

Brian~
This just stinks...I hope it get resolved IN YOUR FAVOR...SOON!

K

[sgerrard]

Hi Brian,

I thought I would describe my Preferred Provider Organization (PPO) plan, since it is a little different from what you described. Maybe it qualifies as the hybrid you mentioned. This is a plan through a fairly large company, it might not be available to a smaller start-up like you are in.

We have a primary care physician, who is supposed to make referrals to the specialists. They prefer you to go in network, but will support out of network in some cases - Cyberknife at Stanford, for instance. We pay the first $250 each year (the deductible), then 20% of all covered charges. However, there is a maximum out of pocket per year of $2400, so you never pay more than that. That last provision makes the PPO just as beneficial for major medical situations, since it limits your total expense when things go into the 5 or 6 figures range.

I am very happy with my insurance, as you might guess, so I just thought I would let you know that some PPO plans can work out well.

Steve