I am a healthy 36 year old male with an HMO insurance policy I pay for
myself. I have a friend in his 40's that was diagnosed with a
relatively treatable form of cancer. Basically, his HMO insurance
policy has flat out chosen not to pay for certain procedures that
could help his condition because they are "not medically necessary".
(For example, an MRI, more specialized tests, and they will NOT send
him out of state to a true cancer clinic) He has also informed me, and
I have been able to confirm this with a little research, that it is
not possible to sue an HMO insurer for damages, which means if they
decide to not treat your condition due to a technicality or provide
poor treatment, you have no true financial recourse.
Now... This sucks because I was under the belief that an HMO policy
was pretty great unless you wanted to go directly to specific doctors.
As it turns out, an HMO is truly inferior care in the event of a
I was never previously interested in a PPO plan because I thought
they were too expensive (20% deductable) for the luxury of going
straight to a preferred doctor.
I have made a decision to switch to a PPO policy. I will pay about the
same per month in premiums, but I will pay significantly higher for
each visit to the doctor. (Which right now I do very infrequently) In
the event of a possibly fatal disease or condition, I believe I have a
better chance of a true diagnosis and recovery with a PPO plan.
My question is this:
As a Nevada resident, what is the best PPO medical plan for me.
My requirements are:
1) I need a reasonable monthly premium. $60-$200 per month.
2) I need a 20% or less co-insurance
3) I need insurance for Nevada, but I want to have California
hospitals "In-Network" for true emergencies. (In Nevada, the saying
goes, if you get sick, you get on a plane and go to California for
4) The company must have a B+ or higher A.M Best rating.
5) I would like some discussion on "why" your choice is the best one.
Basically, I want the most for my money, but I'm switching to the PPO
as true insurance to cover a serious illness if one occurs. I know
that it will cost me more overall, and that's OK. I don't want a
bargain, I want coverage. My friend was able to have his wife's PPO
insurance step in and cover him in the end, but they were ready to
take out a 2nd mortgage to pay his $100,000+ medical bills. This
would be absolutely devastating if it happend to my family.
Any comments from folks that have had a run-in with HMO vs PPO are welcome.