Monday Polly: HMO or PPO?
Monday - January 21, 2008By: Charles "CZA" Sweet
As I'm writing this, I just keep counting down the days until a bruva can be set free from my plantation... err, I mean job, so I can pursue this Urban Journalism more fully. Until then, I'm punching that time clock just like y'all are. I strongly believe that we (and not just the African American side) as a people weren't meant to have to subjugate themselves, doing menial tasks for their daily bread. Feel me? Adam and Eve had it best, running around in the garden bucked naked doing it REAL big (no homo).
Back to the subject at hand, the reason I brought up the "killing fields" (and not so much the body, but the soul and the mind, but let's stay focused) is if you happen to work at a somewhat decent spot, you'll be offered a benefits package that includes health insurance. Since every company is different and can offer drastically different options than the next, I want to just go over a few of the more basic aspects of a package and lace y'all with game about what they really mean. Just a warning: I'm not listing EVERYTHING here; that would be too much info and some things may not match up with your particular company or their respective packages. Check with your human resources department to see what's up. Without further ado; wherever I go, you goooooo...
I'm trying to live as long as Mother Teresa baby, real talk!
The most common types of health insurance plans are HMO and PPO. A Health Maintenance Organization (HMO) is really a company that contracts with various doctors, hospitals and other providers, and offers more patients to them in exchange for a discounted rate to the patients in the form of copays (flat fee) In '73, an act was passed saying that any company with 25 or more employees had to offer federally certified HMO options. A restriction with this is that you have to pick a primary physician in the HMO's network that then authorizes anyone else that they think you might need to see later, including specialists or others who work in the field, but aren't considered essential, to maintaining your health. The main drawback of this type of plan is that if you need medical attention somewhere inaccessible to your main doc, you're more than likely paying full price. You know as well as much as I do those medical bills can get astronomical damn fast. Emergency room visits usually don't fall under that rule, but don't quote me. Some of the more popular HMOs are Aetna, (which I use because of the beautiful $20 copay they provide) CIGNA, Kaiser Permanente and Wellpoint, respectively.On the other side of the coin is the Preferred Provider Organizations (PPO), which offer discounts after a set deductible is met yearly. Many people go with this choice because you aren't limited to an in-network physician and can often come close to what you would get in an HMO plan. The bad side about PPOs is that they can create problems in the health care industry, due to many requiring you to pay claims in a certain timeframe to take advantage of the discounts; the additional step of calculating the discount and having the insurer pay the access fee can easily get backlogged. Still, it's better than the benefits that uninsured get, even if they pay cash. That's crazy, right? Exclusive Provider Organizations (EPO) are similar to PPOs, but the only difference being that if you went to an out of network doctor, you don't receive ANY coverage at all versus the PPO, in which you would just pay more for going to a non-preferred provider.
That should sharpen your pencils a bit and give you some ammo for when you want to decide what plan is best for you and your family. Look out for me next time and keep it movin', shakin' and prosperous. Hit me up at themondaypolly@gmail.com and drop some comments below so we can keep ourselves up on game. Until then...Uno Bravado!
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