New health care, PPO to HMO

[mjuszczak]

Hi all,

I've lived in New Jersey for quite some time now (my entire life). I've had a PPO for most of the time, and I've enjoyed a really nice primary care physician (I have his home phone #, the whole works, and he keeps me CALM!)

Anyway, I have a job offer in Boston that is too good to pass up. Its a nice raise, and I've always wanted to live in a city for a little while. The only thing holding me back is the health benefits.

When I call my doctor here in Jersey, I can get a same day appointment, they are really nice to me, sometimes they make minor mistakes -- they are small family practices, but for the most part, I'm happy with my care.

I know the health insurance at this new job is a blue cross blue shield HMO. I know with the HMO I need referrals and such. I have high blood pressure, and I'd like to follow up with a cardiologist like I do now, and I'm hoping that a primary care doctor in Boston would be willing to do that for me (give me a referral to a cardiologist).

Apparently, if I get myself registered with a hospital, I can go see almost any of that hospital's doctors, and I hear at some hospitals the doctors are somewhat friendly and very smart.

In conclusion - What do those with experience think of Boston doctors? Do you find that if you pick a good one (say at Massachusetts General), that they are usually fairly knowledgeable and friendly, or do they try to rush you out and aren't really descriptive about issues, etc. like I've seen some New York doctors do? Can anyone recommend a good doctor to team up with? How about a good primary care in downtown Boston?

I really don't want this health care thing to be a deal killer if it doesn't have to be, but it IS important to me.

Thanks!

-Matt

[peekawho]

I had a Blue Cross HMO in Detroit, and I wasn't 100% satisfied with it.  It was adequate, but I had to jump through hoops to see doctors that I wanted to see.  For example, I could see any gynecologist, but I needed surgery and wanted it at a particular hospital that was not part of the HMO.  
So I had to switch HMO groups (fortunately, the gyn was part of the new HMO, too) just so I could go to this particular hospital.  
but my PCP was NOT part of the new HMO, so after I had my surgery, I had to switch back to my old HMO.
It was do-able, but frustrating.  

I have a BCBS PPO now, and I love being able to self refer.  If you don't have any very unusual health problems, you'll probably be fine with an HMO.  But some PCPs won't refer you to a cardiologist just for hypertension (mine wouldn't with the HMO).  

I have to see a cardiologist now for a problem, and with the PPO, I just pick up the phone and see who I want.  

The deductibles are a bit higher with our PPO, but not outrageous.

[debaser23]

I can't advise you on what Boston doctors are like.  I would imagine that you could find a small family practice in your HMO that you'd be happy with, though.  

A couple of years ago I was on a PPO that was really great.  Then I moved to a new company and got into the HMO.  Honestly, I didn't see a big difference.  I didn't even have to go into my doctor's office to get a referral.  When I thought I needed to see a gastroenterologist, I just called the PCP's office and they faxed me a referral.  No trouble at all.

I'm about to be a part of a new HMO group and I don't think it's going to go quite as smoothly because it's associated with a hospital in my company's home town.  That's a couple hundred miles away from here.  I've heard it's great insurance, but if I get sick it's certainly not going to be fun making that trip!  

But you're probably not going to have issues like that.  You can always maneuver within the system like peekawho did.  

I had BCBS in Texas a long time ago, and they were great in the beginning but got worse over time.  I was self-employed and ended up switching to something else, but it's probably completely different in Boston.  

If you end up with a PCP who absolutely refuses to give you a referral, simply switch PCP's.  

The only problem I encountered in making the switch from PPO to HMO was that the doctor I was seeing at the time absolutely hated dealing with HMO's and wouldn't under any circumstances.  I mainly liked to go to her because she was just down the street and was pretty damn good looking.  The doctor I ended up with under the HMO actually gave me better care as it turned out.

When you start with your new outfit, ask your co-workers who they're using for a PCP.  That's what I did.  It worked out.

Sorry to ramble.

D

[Jordy]

I completely agree with debaser23.  I've had the same experiences.  I got used to having a PPO for years, and got pretty good and knowing who I needed to see and when.  When, through a job change, I ended up with Blue Cross HMO, I ended up going back to a PCP I had many years ago who I loved (I also had moved back to the area for the new job), and learned that all I have to do is call his office for a referral.  I've done that several times.  At one point, when calling for a referral for my regular ENT, my PCP's receptionist insisted I was overdue for a regular physical...so I figured, what the heck, I'll go, it was all covered anyway.  They willingly give me random referrals per my own request otherwise.

Like debaser23 said, if one refuses, just find a new PCP.  The key to success in these situations is researching and communicating fully with your PCP's office and the HMO.  It also can't hurt to have a regular physical once and at that time discuss with your PCP your desire for some freedom in making your own referral decisions, and ask him or her if they will cooperate if it's between regular physical intervals that you decide need a specialist for something.  You tell them what YOU want.  I've found, in my experience, by being fully informed before you make your calls you will have success in getting what you want the majority of the time.