HMOs

[bluey]

When I left my job in 2008, one of my biggest fears was "Will I need insurance?" I was quite happy with my PPO insurance through InCharge (and earlier, the "pretty much everything's covered" dot-com insurance at Citrix). At my height/weight ratio back then, it was pretty much impossible to get private insurance, even HDHP+HSA plans with $5200 deductibles. I went uninsured for 7 months until Tammy took pity on me and we tied the knot.

At first I was a bit nervous about being on an Tammy's plan, as it was a Cigna HMO and I've heard nothing but trash talked about managed care...

• My PPO plans had always allowed me to go a huge variety of doctors. The HMO limited me to... well, choosing from a slightly less huge variety of doctors. I found one I liked and they became my PCP. My doctor's office is rockin.
• The PPO meant I just had to cover my deductible ($200/yr last I remember) each year and then I only paid 10% of the bill. The HMO charged me $20 a visit. I'd have to make several HMO visits a month before I got close to spending as much as the PPO deductible.
• PPOs were always touted as the upper-crust plan, with HMO patients having to wait 2 months to get an appointment, only to sit in an overcrowded lobby for an hour waiting to be seen for 2 minutes before being shuffled off. Under the HMO, pretty much anyone I called for an appointment (doctor, dentist, optometrist, endodontist) scheduled me for the same or next day. Often, they simply said "We've got openings right now. Just stop in."
• PPOs were supposed to be the good guys and help you get treated while HMOs pinched pennies and denied everything. Cigna has approved every single procedure my doctor/neurologist prescribed, including a number of pricey advanced radiology procedures. There was an occasional lag of 3-4 days before it was approved, but that was pretty common according to the medical staff.
• Cigna also called me out of the blue to enroll me in a wellness program because of my height/weight ratio during my last physical. I get a nurse that calls me every month or two to check up on me, ask about diet and exercise, offer advice, forward me relevant news articles or information, etc. It's the first time an insurance company actually took some step *before* I got sick.

All things considered, I've been pleased as punch about managed health care and think that my situation is as least a narrow, anecdotal view of how managed care done correctly can be a good thing.

And I'm writing this HMO love letter because I just heard back that my new $2000/month prescription I'll soon be taking was approved by my insurance company for a $0 copay.