I grew up using an HMO, Kaiser Permanente. I’ve had PPO insurance now for some time, but I’ve hardly done anything with it since I’ve been healthy. I generally had good treatment from Kaiser, but around age 18 I was advised to go with a PPO by family, who said the HMO can be trouble if anything serious happens to you.
I don’t really know how to use a PPO, though. One issue is finding a doctor. I live in a dense area, and if I go online and search for doctors within say a 5 or 10 mile radius, I get hundreds of hits, possibly over a thousand. There’s no info except their name, address and phone, so I have no idea how to pick one. One thing that concerns me is, if I pick some office that has one or two doctors, how would I know they would have an opening when I needed it? I don’t like the idea that I have to hunt around for doctors if something urgent happens.
I also don’t know what happens with my records; I assume an HMO has a centralized records system.
Does anyone have any advice on how to go about using a PPO?
I would recommend talking with people in your area who have the same or a similar plan to find out how satisfied they have been with various doctors. It sounds like you may prefer a multi-physician practice, which also helps narrow down your choices. You can also ask the practices you are considering what is a typical wait time for various types of appointments. And then just meet with a couple of doctors to see who you feel comfortable with.
One of the good things about a PPO is that they usually let you go to any doctor in network at the in-network rates, and still provide some coverage for out of network services. So if something comes up and your regular doctor is available, you can go see another one. It’s not like Kaiser where it’s them or no coverage at all.
Interestingly, the only person I ever encountered who absolutely loved Kaiser was someone with many serious chronic health conditions. She felt Kaiser worked so much better for her because they could coordinate all of her specialist care, rather than her having to do it. Others I’ve known liked Kaiser, because their copays were minimal, but it was a very constrained type of insurance.
You can get your records transferred from Kaiser to the new physician’s office. You will find yourself more involved in managing records if you go to see specialists. But one area where you will have more flexibility with a PPO is decision to see a specialist and choice of specialists.