Review: "Many Flexible Health Plans Come with a Costly Trap" – NPR
December 4, 2015
This is an article written by Julie Appleby on NPR.
In the world of health insurance companies, there are lots of ways to ensnare providers while squeezing every bit of profit out of consumers as possible.
The whole idea of "HMO" and "PPO" falls right in line with this. Interestingly enough, now that people are "forced" to buy insurance, and the government tells the insurance companies that they cannot deny enrolling everyone that asks due to preexisting conditions, the insurance companies that offer PPOs are fighting back by eliminating an upper limit for "out of network" costs.
It's genius really. The PPO is supposed to have every specialty within their network so that PPO subscribers don't have to use "out of network" providers. But alas, since many doctors are now enlightened about their shenanigans, they aren't opting into these types of networks (especially for dermatology, psychiatry, and rheumatology). The result is that some PPO plans don't have certain specialties.
So what's a person to do if they have this type of plan? Chances are, these patients have already paid a premium into the plan as have their employers. Yet since those providers are "out of network," the patient has to pay the provider directly and can then submit their receipts to the insurance company.
It used to be that the insurance company would then reimburse a portion or all of the cost to the patient and life would go on. But that's paying money that eats into their profits. So they started putting caps on it: the patient would have to pay "up to the cap" before the out of network benefits would kick in for the insurance company to pay the rest.
What this article suggests is that now certain companies are saying, to hell with y'all, and not covering any expenses out of network. The retort I hear most often is, "then you should join an HMO." Unfortunately, they're not any better in regards to access, provider satisfaction, and provider accessibility.
[Sound the trumpet] P.S.Y.C.H. is different. When you don't have to worry about insurance, you can go to whomever you feel matches what you need/want. Whether you want to see a dermatologist, primary doc, or get a colonoscopy, you'll know who to go to, what the cost is, and what's expected of you. No more smoke and mirrors.