Well, while it is true that there are both bad and good HMO's, as well as PPO's, you never really know what's going to happen until you get sick.
My personal experience with an illness suggests that I might well not be here if I were using an HMO.
The story told does not convince me of that.
I was extremely grateful that I had a PPO.
If one doctor stands in your way in the PPO system, you simply get a different doctor. Try that with an HMO.
You could do it with Kaiser. Every Kaiser member has a primary care physician. You can change your primary care physician, I was given to understand.
Further, in the example given, if an HMO concluded that you didn't need treatment, and even if they did not allow a change of primary care physician, you could still go to an outside doctor and get an opinion. That isn't terribly expensive.... And then, assuming the outside doctor said you needed treatment, in writing, you'd have ammunition to use to get your HMO off its duff.
Further, while the bad news is that you can't sue your HMO, the good news is that HMOs are required to provide an arbitration procedure. You are not without recourse. Arbitration should be much faster than suing!
Ask Mr. Baggett, when potentially your life is on the line, "less restrictive" could literally be a lifesaver. And that's worth the paltry difference in price between the two to me.
The difference in price isn't paltry. Other options similar in level of benefit to Kaiser were double the cost, as I recall, when we were in California.
Kaiser, if I'm correct, was pretty much the original HMO. Now, what one sees, if I'm correct, is insurance companies masquerading as HMOs. They aren't really owned or controlled by the doctors who practice in them; rather they are owned by suits.
Basically, if you want to have complete freedom, *and* you want someone else to pay for the services you receive, you have to come up with the average cost of that freedom in advance, as insurance premiums.
Now, if you buy high-deductible major medical insurance (perhaps with a widely-accepted PPO like PHCS, and set up an MSA to pay the deductible, you basically *do* have freedom. You are paying for routine medical care, out of tax-deductible dollars. (But, as I mentioned, you can't get the tax-deductible MSA in Massachusetts).
My point is that I would not suggest making the decision simply on the basis of "HMO bad PPO good." There are a lot of other factors. Some HMOs are better in quality of care than some PPOs.
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