Anthem HMO vs Blue Shield PPO (Covered California)
Welp, another year, another change-of-insurance, as my previous provider (Oscar) is leaving my state. In short, I'm 56, a freelancer who buys his plan on the exchange, and this year I seem to have a choice between Anthem's HMO (which is pretty affordable) and Blue Shield's PPO, which is . . .expensive as hell (like, almost $1,000/month with subsidy, whereas the HMO is a small fraction of that). On the one hand, ALL of my existing providers are in-network with the PPO, including a couple of fancy specialists I pay out of pocket to see. On the other, I'd have to choose a new primary care physician with the HMO (which is fine: I don't love the one I've got), and only a couple of my specialists are in-network. The hospital I prefer is also in-network with the HMO. My question is this: having never had an HMO, does the referral process really create problems? Broadly speaking, my health is OK, but . . . this past year I had a cancer surgery (successful) and now go out of pocket to see a specialist I like every few months. That specialist is in-network for Blue Shield, out of network for the HMO, and still, it's cheaper to pay out of pocket to see him a few times a year than it is to pay for the more expensive plan. (If push came to shove, too, he has a colleague–whom I also like–who's IN network with the HMO). People who've dealt with HMOs, or who have Anthem's HMO in California . . . does the referral process create bottlenecks? Does your primary care provider tend to resist offering a referral? If I have to go to the hospital (which is IN network) will I end up with a bunch of people who are not in my network (anesthesiologists, or whatever) racking up extra charges? I'm inclined to go with the HMO, since just about everything else–out of pocket, what's covered and what isn't–is identical, so it's ridiculous to pay a huge multiple just for a larger network, but informed opinions from anyone who's dealt with Anthem and/or HMOs in general (besides Kaiser) would be deeply, deeply appreciated. Thank you
submitted by /u/WarrenOats
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