HMO, PPO and HSA

HMOs generally require the patient to use a primary care physician, who functions like a gatekeeper, giving you referrals to specialists as needed. So your satisfaction will depend on a helpful & cooperative relationship with the PCP & office staff at his/her practice location. Look into the physician network your employer's health insurance contracts with to get an idea which doctors/clinics/hospitals you would be entitled to use. PPO is more expensive because it gives the patient a broader choice of health care providers overall & the choice to go directly to specialists. HSA is best for income tax deduction purposes-- I think this suits higher income patients mainly. BTW, how are you doing with Salix-- did they send you any additional notice RE Colazal lately? / Old Hat (31 yrs with left-sided UC; presently in remission taking brandname Colazal)

My only option through my employer is an HSA. You have to have high deductible insurance with an HSA (mine is $2,600). Once I reach the deductible everything is covered 100%. An HSA is funded with pretax money and if used for medical expenses there is no penalty to withdraw the money. I've never met my deductible so I end up paying all my medical out of my HSA. Sounds like you'll have to run some numbers. If the cost of the PPO is more than the cost of the HSA and its deductible, then it may be better to go with the HSA.

Thanks for the replies everyone. But with referrals, do you need to get a referral each time you go to the same specialist or do you need a referral just for the first time?

Old Hat said...
HMOs generally require the patient to use a primary care physician, who functions like a gatekeeper, giving you referrals to specialists as needed. So your satisfaction will depend on a helpful & cooperative relationship with the PCP & office staff at his/her practice location. Look into the physician network your employer's health insurance contracts with to get an idea which doctors/clinics/hospitals you would be entitled to use. PPO is more expensive because it gives the patient a broader choice of health care providers overall & the choice to go directly to specialists. HSA is best for income tax deduction purposes-- I think this suits higher income patients mainly. BTW, how are you doing with Salix-- did they send you any additional notice RE Colazal lately? / Old Hat (31 yrs with left-sided UC; presently in remission taking brandname Colazal)

No, they haven't sent me anything. Not even the letter they said would be sent notifying me of the discontinuation. I got Apriso but either it's not doing anything or it made me worse because a couple months after starting Apriso I'm now at the beginning of a flare