Are HMO's good for diabetics

Joseph32
By Joseph32 Latest Reply 2012-01-22 21:17:26 -0600
Started 2012-01-14 22:12:38 -0600

I found out last march that I have type 1 diabetes. I had no medical insurance and made to much money for gov help. I now have a job that offers medical insurance through Aetna. My options are an HMO or a POS II. Not sure what plan is best for diabetics. I also have neuropathy. I'm excited about getting the chance to have health care for the first time can anyone help thanks


6 replies

pixsidust
pixsidust 2012-01-16 21:01:44 -0600 Report

PPO is the way to go. NO ON THE HMO!

You can just go to the doctor without a referral to go to one with a PPO. In an HMO you have less options and you need a referral to go to a specialist.

United Health Care's HMO challenged a co-workers ER visit because she went there without a referral. She fell on the ice and broke her leg.

Another HMO challenged my ex husbands claim when he needed stitches because he did not get a referral from a regular doctor.

My sons HMO challenged his ER visit when he broke his heal bone in around twenty places. The doctor said if he had put weight on it it would have shattered. The doctor wrote accident on his record and they wanted to know could we sue someone else for the bill!

If you have a choice do not choose it!!!!

kdroberts
kdroberts 2012-01-22 21:17:26 -0600 Report

Every single insurance company will automatically ask you if another party was to blame if you have any procedure that could be related to an accident. Stitches, casts, splints, etc. I've had several from my PPO over the last couple of years for various injuries to family members. They also want to find out if it was work related and subject to workers comp.

HMO plans can be very good and economical if you have a good network around you. If not, they can really suck.

kdroberts
kdroberts 2012-01-16 20:40:26 -0600 Report

It depends on what the coverage is, how much it costs and what networks are available in your area. However, you may have a potentially huge issue. Since you have diabetes but don't have insurance it's highly likely that any diabetic related claims will not be covered for a period of up to 12 months, if there is a pre-existing condition waiting period on the plans. You should find out of one or both have one and if one doesn't, that's the one you go with. The other thing you have to keep in mind is that your choice is just until the end of the year. Some insurance is better than no insurance and if the plan you select doesn't work for you you can change it next open enrollment.

berryj09
berryj09 2012-01-15 04:45:16 -0600 Report

I believe this website will be helpful to you Joseph. I stumble across it and had happened to stumble across your post a few minutes earlier…hope this helps.

http://www.agencyinfo.net/iv/medical/types/hm...

door331
door331 2012-01-15 06:47:32 -0600 Report

Oh that was a great link, thanks for sharing! I had never heard of a POS plan- generally I prefer a PPO option because I like being able to see a specialist without getting a referral. The POS sounds like it is a combination of those two types and might be worth looking into— you would really need to look at all the details (Co-payment, premiums, Med coverage, Rx coverage) to see which one will be better for you $$ wise.

I do recommend finding an endo who is also board certified in Internal Medicine— that way if you use an HMO you can keep your Endo as your Primary— this makes it much easier to get referrals if you need to see other specialists.

-Eric

Next Discussion: Diabetes Myths2 »