Urgent question about choosing insurance- deadline tomorrow!!!

[kuttakamina]

I need to choose between two health plans by tomorrow afternoon and I'm struggling with it, because I don't know how the health system works and what plan would be best from the viewpoint of getting treatment for hiv.

There is Blue Cross PPO where the premium is higher by about 20$/month and then there is Blue Cross Plus. Does anybody know a hiv doctor in SoCal who is also an MD (internal Medicine)?

Because with PPO I don't have to choose a doctor, but I have to with Plus. I'm new to the area and don't know any doctors. How do I do that?

Do I just pick any doctor and hope he's an Infection Specialist or do I go through some hiv/aids organisation in picking one? The, do I call the doctor and ask if he's accepting new patients?

Or do I simply go through any AIDS organisation in SoCal and expect that they would accept BC plus?

It's very confusing and any information would be helpful. I understand that you are under no obligation or liability to provide me any information to help me make a decision SOON.

Thanks a lot!

[Grants Committee]

Hi kuttakamina:

Your insurance plan should have provided you with a directory of health care providers and you should be able to pick one from there. 

Many times they only list General Practice doctors - or at least that is all they let you select as a PCP (Primary Care Physician).

Do you know if your plan is "Open Access?"  Open access means that you can see a specialist (which ID docs are classified as) without a referral. 

My current plan and my last one were both HMOs - but both were open access - so even though a picked a PCP with my old plan - I only saw her one time - as I am more comfortable with my ID doc and the plans were open access - allowing me to see a specialist without a referral.

Most PPO plans have a larger network of providers - or even let you go out of network sometimes - but they typically have higher out of pocket expenses.

With our PPO and HMO plans they both offer similar benefits - except the PPO requires a payroll deduction every pay period - where the HMO is 100% employer covered (so, that is the one I went with). 

You might also check the website for your insurance plan as it probably allows you to search for docs - then compare that with docs listed on local ASO - or do a google search about local docs who specialize in HIV.

Hope this helps.

[phildinftlaudy]

OOPS - posted under wrong screenname -
My apologees ----

Same advice kuttakamina - but put it under my screenname (phildinftlaudy) and not "Grants Committee."

-Phil
(who just fell on his sword)

[AaronbytheC]

I have a BC PPO and have had no issues with my doc and coverage. 
True a PPO usually cost a little more, but there are usually more freedoms with it and as sad as it is to say, in the US you get what you pay for.    

Another thing to look at is drug coverage and copay...  BC is good at not covering name brand drugs!   

I'm up in the Monterey area not down in SoCal, but I'm sure there are plenty of good ID docs down there who will take a BC PPO.  If you're new to the area I'd find the local ASO and ask for a list of doctors, maybe talk to a few of them before choosing one.  We all know a good doctor relationship is important!

[kuttakamina]

Thank you all for your responses. Aaron, I wish I had more time to call doctors and find out what is covered or what is not, but I'm low on time.

I think I also read just in the last hour something about with new insurance they will not treat a pre-existing condition for at least six months. In that sense, I suppose it's a moot point which provider I go with as I probably can't see a doctor for six months anyway. I did not have any insurance in the last six months let alone one for hiv.

So, I guess I will do a toss and go with the PPO or the Plus, the difference in premium is no more than $20, but I think with PPO there's a lot of 20% payment out of my pocket but Plus seems to not have so many charges. So, in the end, is it possible I'm short-changing myself by saving the $20 dollars a month? It is possible, but I guess I'll take my chances and bear the consequences.