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  • Saving $480 per year vs. Full freedom of choice

    I know that having a PPO doesn’t necessarily ensure better medical care, so every year at open enrollment time, I think about switching medical plans. Unfortunately, none of the doctors that our family sees are HMO providers, so every year, I decide to stick with our PPO plan. This year, a new PPO plan was introduced – it costs $40 less per month but only has half the number of doctors in its network (co-pays and deductibles remain the same). The boys’ pediatrician and our primary physician are members, but my beloved ob/gyn is not.

    I am thinking about switching plans anyway. I have about a month to decide. The problem is that I adore my ob/gyn, who saw me through two miscarriages and two somewhat difficult pregnancies. Based on conversations with many friends, I am convinced that he is a superb doctor who keeps up with the latest in medical advances and is an extremely skilled surgeon. (Too many people I know can’t believe how quickly I recovered from my c-sections.) He is also part of a practice that is really well-run – I’m never in the waiting room for long, the business office responds promptly, and my doctor always calls me back within a couple of hours when I leave a message. I certainly can’t say the same for all of my other doctors.

    If there was another in-network ob/gyn that I knew I’d like, I would make the switch. If one of the other doctors in the same practice was part of the new network, I’d think about it (I’m sure my current doctor would understand). But with neither of those circumstances playing out, I am thinking that I will just stick with our current plan.

    The other concern I have is that if we get referred to a specialist, I’ll forget to make sure they’re part of the new network and end up having to get a new referral at the last minute or owing a lot more money because I used an out-of-network doctor.

    So, what would you do? Would you switch plans, or would you stick with the current one?

    Comments

    1. We have the same dilemma every year.

      On the advice of several family members who are doctors in our area, we have stayed with the PPO. Ours does not have a co-pay, so the actual 10% of a doctor’s visit is often less than the HMO co-pay, somewhat balancing the higher cost per month.

    2. Chief Family Officer says:

      Meredith – Oh, I’m envious! I wish we didn’t have a copay, but ours is $20 per visit, except for preventive visits.

    3. I’m a big fan in staying with a doctor I like, but that’s probably because I don’t find them very often. In my experience, the numbers might still work in your favor, especially if you don’t plan on visiting your doctor often:

      -How much does your doctor charge for a routine visit? What other kinds of charges might you expect? Would he be willing to discount his regular price if you pay in cash? Perhaps 5%?
      -Would the doctor be willing to do your lab work through a lab that is in-network? They usually have options, but don’t offer them to patients unless requested.
      -What percentage does the PPO pay for out-of-network providers?
      -What’s your individual deductable? You have to pay 100% of charges until your deductible is met.

      If you save $480 over the year in insurance, it’s still worth it. Especially if you can establish all of your expenses beforehand, which will allow you to better estimate your FSA dollars. You might also get a chance to find out what the billing office is like, which is not always as pleasant to deal with as the medical office. Something else to keep in mind :-)

    4. I would probably consider switching plans but sticking with the current provider, to see whether that makes financial sense. Otherwise, $480 isn’t that much money in the great scheme of things.

    5. I would not give up your doctor–good OBGYNs are hard to come by, and it’s really important as you get older (esp as a female) to have a solid relationship with one doctor who knows your body well.

      But that doesn’t mean you can’t switch plans and save money. You can always pay out of pocket for your beloved doctor. If you are currently only using your OB for annual visits and don’t anticipate a pregnancy in the coming year, then your annual out of pocket costs even without insurance might be well under $480.

      Even if you develop some complication in that area, you’d likely be referred to a specialist for any necessary tests and procedures–and you could make sure those medical professionals are on your new plan.

      I’d ask my OBGYN’s receptionist about it and get the rates for the services you currently use.

    6. Thanks, everyone! I will definitely ask my doctor what the current rates are and figure out what I would be paying out of pocket because you’re right, I may easily pay less than that.

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