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Tips on Choosing Your Health Insurance – PPO vs HMO vs EPO and a Story

Posted Feb 25 2011 10:30am

Recently a patient came to the office with the need for a complicated breast reconstruction after finding that she had a Brca gene. She had already had breast surgery and radiation therapy and now was looking at complete breast removal and reconstruction. She was pretty clear that she had no money to pay for anything, but was waving around her Blue Cross PPO card like it was a VISA.

What was she even doing with a PPO card?

When patients sign up for PPO insurance, they are basically saying: “I am willing to pay more, but I want choice.” PPOs generally allow patients more selection with coverage for doctors (both in and out of network,) but patients pay a higher share of cost for that care. When you are on the cusp of expensive breast cancer surgery, a PPO card means you are going to pay thousands if not tens of thousands of dollars by the time you go through the multiple operations to remove and re-build your breasts.

HMO plans on the other hand have limited doctors (less or no coverage for out of network) and hurtles to care, but once you get in for that care, it costs you less.

EPOs tend to be somewhere in between. Now with this being said, each plan by each carrier can be quite different. Plans often have multiple deductibles for in and out of network doctors, facilities and hospitals. You really need to look into your plan before you sign up for it. But if you are looking to pay little or nothing over and above what your insurance pays, you should be looking into HMO coverage most often.

Best Regards,

John Di Saia MD

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