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HMO's

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Dantheman:
Just curious, how many folks had an HMO for insurance, and did they cover all of the surgery or did you owe the Dr.'s some money at the end?

I have an HMO, live on the southern tier of NYS and am a little concerned about debt.

Dan

ppearl214:
Hi Dan,

I have BC/BS of MA PPO, so I cannot answer your question.  Does your HMO provide a customer service dept that you can inquire about what is covered and what facilities they do cover? If you decide to go out of your plan, they should be able to help you determine just how much will be out-of-pocket.  I know many treating facilities will talk directly to medical coverage providers as well. 

I know there are a few folks here with extensive insurance expertise so I'm hoping they chime in to help guide you better than I can.

Phyl

nancyann:
Exactly Phyl,

Check with your customer service - the phone # should be on the back of your ins. card.
And the facility in network should help out with checking with the HMO re: coverage.
Personally, I can't imagine an HMO not covering this serious surgery !!!

Best Wishes, Nancy

ppearl214:
Bruce,

When was the HMO contract for your coverage renewed?  If it was recently, that may be why the "pre-existing" claus no longer is there... just a thought. I've run into it before as well at time of contract renewal.

Phyl


--- Quote from: brucifer on January 23, 2007, 01:35:13 pm ---I just called my HMO (BC/BS) today, and they cover everything except for the deductibles. The strange thing though is that in the literature it stated that there was a pre-existing condition clause, yet today they tell me that they have no such clause so that I could have been treated months ago. I guess it really is worth giving your insurance company a call first to get the particulars.

Bruce

--- End quote ---

Dantheman:
I'll be in contact with the HMO (CDPHP) soon. I have my final appointment with my Otologist next week. All my testing was completed last week. I hope to get a surgery date soon.

My HMO doesn't have Otologists nor Neurosurgeons in network...that's the thing. Deductables don't worry me. It's all of the paperwork the Dr's have you sign that state you will pay what the insurance won't cover. That's what worries me.

So far, CDPHP has been great...

Dan

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