jmw
Level 2 Member
At this point in my life, some of my family members have health issues. Gone are the 20s and 30s when we only needed to visit the doc once a year or less. As health conditions begin to accumulate, I feel like the docs are prescribing meds and then shoving you out the door. My current HMO Kaiser treats cookie cutter illnesses very well. But some of the illnesses are not cookie cutter anymore. My copays for all of this is very low, but I'm not seeing satisfactory results with non-cookie cutter illnesses. Appointments are often rushed. Getting an appointment can be difficult and long in certain specialties. Once in a while, treatment options are delayed or denied. Second opinions have to be inside Kaiser, which is pretty worthless since they have a groupthink model based upon evidence based medicine, which sometimes is based upon research that is poorly designed from a statistician's point of view (eg. not everything can be double blind due to ethical concerns). This month, I made the decision to start going out-of-network for dealing with the HMO failures.
At my work, there are three policies. One is Kaiser (current plan - very low copay). One is an HMO with zero copays but has access to a very good medical group. That medical group happens to have a concierge practice as well as an executive practice. The third is a HMO/PPO/POS hybrid with $20 copays and out-of-network access. There is no HDHP option at work. The FSA option is available, but I already burn through it every year without much effort. For myself, it doesn't matter which policy I pick. For the sick members of my family, it makes a big difference.
Originally, I was thinking about choosing the POS policy so I can get some of the OON paid. Then I started to worry about whether or not insurance will pay for the prescriptions and tests ordered by the concierge doctor. If they're going to deny my claims, I might as well go with the zero copay HMO with a good medical group and pay everything else out of pocket. I have no idea if this fear of non-payment is justified with OON benefits. I even thought about getting HDHP from the marketplace, but the cost is still steep and the network limitations make the insurance portion not worthwhile versus the non-Kaiser policies at work.
So my thinking is that I use the cheap HMO policy to pay for oh crap moments and stuff that is easy to fix. For services that the HMO does not do well, pay out-of-pocket cash. Anyone else have experience with this? I'd be very interested to find out what doctors choose for their family healthcare.
At my work, there are three policies. One is Kaiser (current plan - very low copay). One is an HMO with zero copays but has access to a very good medical group. That medical group happens to have a concierge practice as well as an executive practice. The third is a HMO/PPO/POS hybrid with $20 copays and out-of-network access. There is no HDHP option at work. The FSA option is available, but I already burn through it every year without much effort. For myself, it doesn't matter which policy I pick. For the sick members of my family, it makes a big difference.
Originally, I was thinking about choosing the POS policy so I can get some of the OON paid. Then I started to worry about whether or not insurance will pay for the prescriptions and tests ordered by the concierge doctor. If they're going to deny my claims, I might as well go with the zero copay HMO with a good medical group and pay everything else out of pocket. I have no idea if this fear of non-payment is justified with OON benefits. I even thought about getting HDHP from the marketplace, but the cost is still steep and the network limitations make the insurance portion not worthwhile versus the non-Kaiser policies at work.
So my thinking is that I use the cheap HMO policy to pay for oh crap moments and stuff that is easy to fix. For services that the HMO does not do well, pay out-of-pocket cash. Anyone else have experience with this? I'd be very interested to find out what doctors choose for their family healthcare.