[boogiesmash]

Ppo vs hmo. What is the difference and which one is better or worth it?

Right now I have aetna hmo and need referrals.

[BeyondtheRainbow]

Both as a patient and former clinician (OT) I prefer PPOs. You get more control over who you see and when you see them than you do with an HMO and in general PPOs were more reasonable in what they would cover for my patients than HMOs. Like one HMO once cut off my patient's treatment because her stroke was really bad and she had to start t a very basic place and the HMO said if she wasn't able to work on more advanced goals she didn't need therapy (had she been given time she might have gotten to those goals). PPOs can be more expensive.

HMOs are sort of a network of providers and you have to stay in that network for all covered care. You need referrals to see specialists and getting a referral can be hard depending on your regular doctor. PPOs have a lot of providers you can choose from. You can self-refer to specialists and select any hospital/provider in the PPOs network for any admissions/procedures/tests/etc.

[scatterbrained04]

I'd go for the PPO.

If you go HMO, you must first check that the closest hospital is in the network and that there are enough doctors (primary care plus the specialists you need such as psychiatrists and therapists in the plans networks--and the networks can change from year to year).

With a PPO, you can go to anyone but you still have to check to see if your hospital and doctors are in the network. When you go to someone out of network, the deductible and copays are much higher; so, if you are on a budget, it is always wise to do you homework before signing up for a plan.

The best way to see if the local hospital and your doctors take your plan's insurance is to call their office and ask. There are some plans out there with very small networks or networks on the other side of your town.

[reb569]

Agree with all the above. PPO and be sure to check your provider network.

I have PPO. When I had HMO, it was a pain in the f_cking @ss. Yes, PPO is more expensive, but it's well worth it. Besides, I also have physical health issues and it makes getting specialist appointments a breeze. I hate the "referral" stuff that comes with HMO.

[~Christina]

PPO more choices.

HMO you need a referal for E V E R Y T H I N G .. And often they deny anyway....

[WildcatVet]

Husband is Aetna HMO and has to drive 50mi just to see his GP never mind a specialist. He's been waiting over 6 months for a referral...