Am I kidding myself in believing that I will receive better medical care (ie: be prescribed better medicines, receive better tests, etc) if I switch from my HMO to a PPO with the same insurance company?
Some people will say that it doesn't matter how the provider organization gets paid, all patients receive the same quality of care. And that's how it should be and quite frankly it is disturbing to think that it could possibly be otherwise.
However I am unhappy with the care I have received since I started needing more frequent medical care and for that reason I have been thinking about selecting the PPO plan offered by my employer rather than the HMO plan I keep selecting every year because it's the plan with the lower premium…
If I ask for a more effective medication (which based on my research actually exist) all I hear from my doctors are excuses for not prescribing the medications and almost all of those excuses have to do with insurance coverage and rarely do I hear any excuses related to the medical appropriateness of those medications. They can't even bother to write a prescription because they are certain the insurance won't cover it. ( There have been times when they were wrong and it turned out that the medicines were covered by my plan, but I had to go out of my way, dig up my plan's medical policies, and present those medical policies to my doctors. )
I cannot say that the quantity, intensity, frequency of the medical care I have received stems from the fact that I have an HMO plan, since HMO plans is all I know. Maybe I am just expecting an unrealistic level of care. Maybe I need to stop researching possible treatments for my conditions and start defering blindly to my doctors. But I would like to try a PPO plan and see how things go. Worst case scenario everything remains the same and I wasted a few extra hundred dollars on a plan with a higher premium.
I likely won't be using the PPO to see out of network providers (everyone in this part of the country seems to be in-network with the plans offered by this insurance company). I also don't expect to benefit from having the ability to see specialists without an insurance referral, since there are specialists that won't see patients without an internal referral / order from another doctor regardless of whether the patient's health plan requires them to have a referral.
If you are familiar with the different types of payment models that insurance companies use to compensate providers, or if you just happen to be have had HMO and PPO plans, would you say that I am setting myself up for disappointment if I switch from an HMO to a PPO for no reason other than to see whether it affects the quantity, quality, intensity, frequency, etc of the medical care I receive from the same doctors?
submitted by /u/Material_Version_879
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