Open Enrollment: Why I’ll always choose the PPO

My open enrollment is set to begin on Monday. I have taken a look at the current medical insurance rates and it looks like I can spend $116.44 a paycheck for a PPO, $95.38 for an HMO, or $64.81 for a High Deductible Health Plan.

If you have read my previous postings you are aware that I have had some major medical traumas in the past year and half. So although I technically have three options for health insurance. I only have one intelligent choice: the PPO.

Between March of 2005 and October of 2006 the doctors I visited submitted claims for over $69000.00 to my medical insurance carrier. This includes two visits to the emergency room, three hospital visits, one major surgery, months of on-going physical therapy, months of on-going acupuncture, multiple diagnostic tests and procedures, blood work, and consultations with 36 different doctors (most of these while I was in the hospital). When all was said and done I covered over $3500.00 of medical costs out of pocket. I will admit that $3500 is a lot of money to spend in a year and a half of hospital visits. And in the end using an HMO instead of a PPO probably would’ve said me more money. But…

Being a member of the PPO allowed me the flexibility to get multiple consultations from multiple doctors without first having to visit my primary doctor to get a referral. My illness was unexpected and sudden. It was also extremely rare, affecting a very small percentage of the overall population. Prior to this point I had been perfectly healthy and would never have guessed something so sudden and severe would happen to me. The one saving grace in all my medical complications was the fact that I could call up any doctor in the area for a consultation. Believe me, when you are sick and scared you want to find the best doctors. And seeing the best doctors often means waiting weeks or months to be seen. Requiring a primary physician’s referral each and every time I needed a consultation, would have been a headache and a waste of time. It also would have forced me to wait longer to see the specialist. And in times of medical crisis you often don’t know how much time you can spare.

So although the High Deductible Plans and HMOs will save me money, there is no way that I will divert from a PPO any time in the near future. Just because you’re healthy right now, (on the day you pick your insurance carrier), doesn’t guarantee you’ll be healthy in the future.

1 thought on “Open Enrollment: Why I’ll always choose the PPO”

  1. This is a perfect example of how general personal finance tips don’t fit everyone, even if they fit the “average” person.

    I hope you stay healthy in 2007. It’s great to have the coverage so you don’t have to worry as much about health issues, but it’s much, much better not to have to worry at all.


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