Insurance Myths & Dragons

Most folks don’t know as much about health insurance as they think they do. It’s amazing how often I talk to people here in Atlanta and other parts of Georgia and hear comments such as these.

I don’t want an HMO plan because they are all bad.

Blue Cross is accepted by all the doctors so it must be the best.

I can’t afford a high deductible plan.

I need a plan with a copay so I can afford to go to the doctor.

I don’t need doctor coverage, just something in case I go to the hospital.

I need a plan with a copay so I can afford my medicine.

I don’t need drug coverage since I don’t take any medication.

We will examine each of these, and perhaps a few more myths and dragons over the next few posts. Let’s start with the HMO myth.

I have over 30 years in this industry and will admit to a bias against HMO plans. But I will also admit that some of the best coverage, and my most satisfied clients, have an HMO plan.

So go figure.

HMO’s are very regimented. Due to the high qualifying standards and lower fee structure, many doctors will not participate in HMO plans. But do not infer from that statement that only doc’s willing to work for less are in an HMO. Actually, the reverse is true. Some of the best practitioners in any given area are approved as providers in many HMO plans.

With an HMO you have coverage as long as you are in network. Move out of network, except in a medical emergency, and you have no coverage.

Unlike PPO plans where your attending doc may refer you to a non-par facility or other provider, it will almost never happen under the HMO system. The result is, you will have LESS out of pocket under an HMO plan vs. a PPO plan.

Another myth is that people say they had to fight with the HMO to get a procedure covered. With any plan, regardless of the structure, your care is guided by the managed care guidelines and you will be encouraged to take the path that has the highest probability of success.

If you want good value for your dollar and want to minimize your out of pocket on a major claim, there are some very good HMO plans we recommend. The only HMO available in the Atlanta area is Kaiser Permanente. Underwriting can be a challenge if you do not know the system so we always encourage seeking assistance and advice from an experienced agent.

Here is a link to review and compare various KP plans.

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