hmo vs ppo for cancer treatment?
I think I might have oral cancer but I want to get insurance before I find out for sure. If I do have cancer would I be better off with a HMO that has a 0 copay, or a PPO with a 20% copay. If the bills are high then 20% can be a lot, but also I'm wondering if I could get better treatment by having the freedom of PPO. Can I get good enough treatment with an HMO, or is there a chance I will have to see a specialist not covered by HMO? ALSO- - ...... if the PPO w/ 20% copay has a "anual out of pocket limit" of 3000, and my bills are say 200,000 - so does that mean I only need to pay 3,000 for the year and not 40,000 ? -(Kaiser for HMO, ODS for PPO - both are the same rate and same deductable - 148 and 1000)
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1 :
It's not going to matter - it's a preexisting condition, and won't be covered. Just because you don't have a diagnosis yet, doesn't mean it doesn't exist - and it doesn't crop up overnight. Neither of these policies will end up paying out. To your specific questions, it will depend on the particular HMO. Many HMOs are spectacular, and would get you treated just fine, if this wasn't preexisting. The maximum out of pocket is the most you pay for the year - so that would be $3,000. And it would reset January 1st, when you'd have to pay another $3,000.
2 :
well get the insurance but do not go to any hospital so you do not have proof that it's preexisting and then go to a hospital and let them diagnose it and act shocked and they will treat it
3 :
If I am reading this correctly, you have not been to a doctor and diagnosed with anything. If that is correct, it IS NOT considered a preexisting condition, it's just the doctors office has to fill out the paperwork correctly. To determine if it is preexisting, the insurance company asks for the FIRST DATE OF TREATMENT. It is the first time you went to a doctor for that condition... not when you had symptoms, that would be an occurrence date. These are 2 different fields on the claim form the doctor sends in.... Moving on to your question. Keep in mind HMO requires that you have referrals for treatment from your PCP, and approved by your medical group. PPO, as long as you stay in network, you can just go to that specialist or other doctor. If it has a OPX (out of pocket max), then that is the max you would pay per calendar year for coinsurance. You may still have co-payments (a set amount you pay ever time you go to the doctor $10, $15, $20 etc). Some things may be excluded from the OPX, so check with them to see what all does/doesn't apply. If you pick a good PCP, you shouldn't have problems with the HMO.
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Title : hmo vs ppo for cancer treatment
Description : hmo vs ppo for cancer treatment? I think I might have oral cancer but I want to get insurance before I find out for sure. If I do have ca...