I can't really answer that. The best solution would be a single payer solution with one nationwide insurance plan the way the British NHS works (with GP-s working in a HMO style pay plan and then acute and long term care facilities) but with private providers. But it's never going to happen in this country so I don't even talk about that.
Is HMO really that bad?
- Thread starter Quattro Pete
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Originally Posted By: Gary Allan
The deductible thing has me
In our plan that's only if it's out of network (not to be confused with HMO type non-referral).
In my PPO plan, the "in-network" deductible is $500 and "out-of-network" is $1000.
Reading all the responses, I still don't see any major reasons why not to switch to HMO. It'll save me about $500/year in premiums and I will have no annual deductible. I am 35 and healthy. I only go to the PCP doctor once a year for a routine checkup. I have no dependants.
The deductible thing has me
In my PPO plan, the "in-network" deductible is $500 and "out-of-network" is $1000.
Reading all the responses, I still don't see any major reasons why not to switch to HMO. It'll save me about $500/year in premiums and I will have no annual deductible. I am 35 and healthy. I only go to the PCP doctor once a year for a routine checkup. I have no dependants.
Originally Posted By: CivicFan
I can't really answer that. The best solution would be a single payer solution with one nationwide insurance plan the way the British NHS works
I tend to agree, but our system has become so corrupt, it wouldn't work. Half the revenue from it would be spent on special interest non sense and it would further bankrupt our country.
I can't really answer that. The best solution would be a single payer solution with one nationwide insurance plan the way the British NHS works
I tend to agree, but our system has become so corrupt, it wouldn't work. Half the revenue from it would be spent on special interest non sense and it would further bankrupt our country.
Tom NJ
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Originally Posted By: Quattro Pete
Reading all the responses, I still don't see any major reasons why not to switch to HMO. It'll save me about $500/year in premiums and I will have no annual deductible. I am 35 and healthy. I only go to the PCP doctor once a year for a routine checkup. I have no dependants.
In your situation (young, healthy, and independent), if you have no problem with the network doctors & hospitals, working through a PCP, and the premiums are lower, an HMO makes more sense to me.
Tom NJ
Reading all the responses, I still don't see any major reasons why not to switch to HMO. It'll save me about $500/year in premiums and I will have no annual deductible. I am 35 and healthy. I only go to the PCP doctor once a year for a routine checkup. I have no dependants.
In your situation (young, healthy, and independent), if you have no problem with the network doctors & hospitals, working through a PCP, and the premiums are lower, an HMO makes more sense to me.
Tom NJ
Originally Posted By: CivicFan
To insist on "market forces" in healthcare is lunacy, IMHO.
Yeah, it's not like the cost of Lasik (not covered by insurance) has fallen 30% for superior procedures or anything...
http://townhall.com/columnists/JohnStossel/2009/07/08/insurance_is_no_answer?page=1
Quote:
The best solution would be a single payer solution with one nationwide insurance plan the way the British NHS works
Wonderful stuff.
http://www.csmonitor.com/2007/1019/p04s01-woeu.html
To insist on "market forces" in healthcare is lunacy, IMHO.
Yeah, it's not like the cost of Lasik (not covered by insurance) has fallen 30% for superior procedures or anything...
http://townhall.com/columnists/JohnStossel/2009/07/08/insurance_is_no_answer?page=1
Quote:
The best solution would be a single payer solution with one nationwide insurance plan the way the British NHS works
Wonderful stuff.
http://www.csmonitor.com/2007/1019/p04s01-woeu.html
What about EPO? The one that supposedly work like PPO but within the network only?
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The doc gets paid to take care of a group of people and all their needs under an HMO plan.
Are all services, regardless of who is providing them (outside of the primary physician - that is, xray, lab work, physical therapy, sleep study) charged against that fixed fee?
That is, is ALL the patients TOTAL COST TO THE HMO ..EVERYWHERE debited upon that fee?
If no, then it's unrealized revenue that can be the only considered a loss/cost. If it's YES ..then just drawing an unhealthy lot of patients can have you working for nothing ..or have them getting less than favorable care.
The little tidbits you're leaving out have me pondering the difference of seeing all of my 1000 HMO patients ...all at fixed costs to see them with a full waiting room every day ..and worrying about seeing half of them more than the other. In a years time I've still had a full waiting room and the same revenue pushed through the practice.
This example is perhaps unique in that it is ONLY filled with HMO patients for the sake of demonstration. Again, if I have HMO patients choking my waiting room and I'm losing money on them since I have to push higher paying insured patients further out in the appointment book ...that's not the same thing as "costing more". That's losing profits.
The doc gets paid to take care of a group of people and all their needs under an HMO plan.
Are all services, regardless of who is providing them (outside of the primary physician - that is, xray, lab work, physical therapy, sleep study) charged against that fixed fee?
That is, is ALL the patients TOTAL COST TO THE HMO ..EVERYWHERE debited upon that fee?
If no, then it's unrealized revenue that can be the only considered a loss/cost. If it's YES ..then just drawing an unhealthy lot of patients can have you working for nothing ..or have them getting less than favorable care.
The little tidbits you're leaving out have me pondering the difference of seeing all of my 1000 HMO patients ...all at fixed costs to see them with a full waiting room every day ..and worrying about seeing half of them more than the other. In a years time I've still had a full waiting room and the same revenue pushed through the practice.
This example is perhaps unique in that it is ONLY filled with HMO patients for the sake of demonstration. Again, if I have HMO patients choking my waiting room and I'm losing money on them since I have to push higher paying insured patients further out in the appointment book ...that's not the same thing as "costing more". That's losing profits.
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