I've had HMO in the past (Kaiser) and it covered a lot of stuff like lab and x-rays, it just limited me on choosing a doctor so I switched to a PPO. I called today to clarify one of the terms because I couldn't believe if I was reading it right, and it basically says that no lab or x-ray is covered until I pay the deductible which is $4500/year. I mean at Kaiser I used to get lab work done regularly such as to check my cholesterol and hormone levels, I've had x-rays before and so on and now I am paying the same and none of that is covered (with my Blue Shield plan). So is it worth switching to a more expensive plan? I feel so disappointed, like the salesman never explained this when I signed up. Seems like a big deal, right? Or am I making a big deal out of nothing? For example if fracture a bone I'd have to pay $4500 just to get an x-ray done.
1st off, do you have your old bills and EOB (explanation of benefits)?
If you do, go back and check out what they charged for the services, any co-pays etc. Add up all of the amounts in every year you had the HMO.
Now compare the cost of the HMO and the PPO?
Say the total amount the HMO paid in 1 year was $500 for labs-x-rays etc. Now say that the HMO costs you $200 per month whereas the PPO costs you $150 per month. The total cost for the HMO would be $2,400 per year whereas the PPO would be $1,800 per year. The difference would be $600 savings per year, so you could pay for the labs etc when needed and save money plus you have a bigger pool of doctors to see under the PPO vs the HMO.
good luck
Just because you have a high deductible, doesn't mean that the plan is bad.
Generally, healthier people will benefit from the high deductible plan, because they'll save on the monthly premiums.
With health insurance, you balance coverage and deductibles to get the plan you can afford.
That is why a lot of people stay with Kaiser.
Switch back to them when you get chance if that works better for you.
It sounds like you're a little confused on one thing...you wouldn't pay $4,500 for one x-ray.
However, it is correct that with a $4,500 deductible, you'd pay the first $4,500 per year in covered services. That's the way a high-deductible health plan works.
It wouldn't necessarily be the $4,500 all at once. (Unless you had one big, expensive service like a hospitalization or major surgery right off the bat.) Instead, it would accumulate as you use services throughout the year. $50 here, $100 there, etc.
If you're healthy, there are advantages to a high-deductible health plan. You pay for the services as you use them, rather than pay a higher premium every month for coverage you may or may not use.
You can also look into setting up a special savings account (HSA) where you can accumulate tax free money to pay your medical bills. (Talk with your agent about this to get more information.)
The type of plan you have can be good for some people, and not-so-good for others. Just depends on what kind of health care consumer you are.
Personally, I would prefer a high-deductible health plan with an HSA, if the option was available for my family. (Its not, so I have a more typical PPO plan through my employer.) However, there are a lot of people who that type of plan might not work for.
With many PPO plans lab and X-rays are subject to the deductible; this is one way they keep the premium lower. The PPO plans cost the insurance company more because they pay the doctor more, so many benefits are subject to the deductible in many PPO plans.
Blue has several different plans in each state, some plans will cover the lab and X-rays without meeting the deductible. You may want to compare the difference in premium to the likelihood that you'll need these services in the future.
If you do need services subject to the deductible the doctor or hospital reduces your charges to the contracted rate so even if subject to the deductible you will get a break on the total cost.