HMO questions, please! (HAP)

[kellia]

We got dh's benefit information for next year. We are thinking of going with HAP, an HMO, because it is a lot cheaper then the other ones and no deductible. My concern is what happens if something happens and we are out of the area where most of the HMO doctors are? Dh works an hour away, so not as many doctors near our home take it like they do near where he works. We'll manage if we're home, but if we go visiting a little farther away and had an emergency, I'd really hate for all 5 of us have to go to the ER and not have any coverage! I also work an hour from home in the opposite direction and nobody around my work accepts it, either.

Can someone please explain how this works? Will HAP still pay if it's an emergency but not one of their network hospitals? Dh's benefit people aren't the best and I can't call since it's through him.

Thanks!!

 

[tifany]

Most plans will cover if it is an emergency . . . . First thing to do would be to check and see if they have preferred providers (ER rooms) in the area. The second thing would be to ask the benefits rep if you are covered under the no-deductible plan if you have an Emergency and can't see a Par Provider.

In other words, your plan can not punish you if you have an accident in Orlando and you have to seek Emergency care. If your plan is for the State of NY and you are on vaction in Orlando, and you have an Emergency, you should/will be covered at 100% because no one can forsee an Emergency. However, you will not seek your "well visits" when you are out of town, you would go to your PCP for those visits instead of a stranger.

 

[nancygz]

Don't be afraid of calling DH's benefit people. As an HR Manager, I'd prefer to speak to the spouse than an uninterested employee. In all my years, I've spent many hours with spouses explaining the plan and helping them navigate the system.

Remember the cheapest plan isn't always the best if it is going to cause a headache every time you need to see a doctor. Think about the last year in doctor visits. Will you have to change everyone's primary physician? If you are healthy, maybe this is the right option for you. A year is a long time if you don't like your health plan.

I wouldn't anticipate that out of area emergencies are covered at 100%. That might be true in NY, but not in CA. I'm on a traditional HMO and out of network costs are paid at a percentage. Emergencies are not covered at 100%.

When I travel, I always try to get a list of what hospitals would be in our network, if the network exists in that area. If there are none, I just know upfront what % of the bill would be mine.

If you have questions about your plan, PM me. Glad to help you think through the best option for you and your family. It's what I've done all my career.

 

[bumbershoot]

Don't be afraid of calling DH's benefit people. As an HR Manager, I'd prefer to speak to the spouse than an uninterested employee. In all my years, I've spent many hours with spouses explaining the plan and helping them navigate the system.

Wow, that's pretty awesome. I wonder if all benefit people are like that (I've noticed a vast difference in opinions from reading posts on the Dis)...

 

[nancygz]

Thanks. I'm a big fan of having open enrollment meetings which include spouses. It helps communication and shows the firm cares.