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Aetna HMO vs. PPO

Hi everyone!  I recently moved here from Oregon so that my husband could attend grad school at OU.  I recently started working at OUHSC and am trying to decide between the Aetna HMO or PPO.  I am planning on getting knee surgery sometime this year, and trying to conceive sometime next year, so those two events are heavily influencing my decision.  I am also trying to figure out if the higher costs associated with the PPO are worth the convenience.  If anyone could let me know what their experiences were with either plan, I would really appreciate it!

Re: Aetna HMO vs. PPO

  • Definitely PPO. I have the Aetna PPO as well. The PPO allows you to choose your own doctors without having to have referrals. That comes in handy for orthopedics, obstetrics and all the other specialties. The downside is that you pay a copay at the doctor's offices and such.
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  • PPO...without question. I used to have an HMO, and it was a horrible experience. HMOs are all about keeping costs low for the insurance company. I now have the Aetna PPO and have had no problems.
  • I used to work as a Chiropractic Assistant, so I dealt with all sorts of insurance. I've never personally had a problem with our HMO (we have Blue Cross Blue Shield) but I saw a LOT of people who did have problems. I would go with the PPO if you've got Aetna (who is my opinion has always been a little more difficult than the average.) HTH! Good luck :-)
  • We have Aetna PPO and, having seen another specialist in addition to my OB this year, it was really great not having to get referrals.
  • I'm going to throw a wrench in things here... Please keep in mind I'm not familiar with Aetna PPO, but I do believe it has an 80/20 pay  scale, correct?

    DH has Aetna HMO.  Yes, it is annoying that he has to go to see his primary doc before going to a specialist, but at the same time, the thing I love about it is the cost issue.  He had surgery on his ankle last year and did not have to pay anything other than his co-pay to see the doc.  Plus, almost all of his prescriptions that he has ever gotten are $5. 

    I am on a PPO plan with another provider and I hate it.  Again, I'm not sure if it's the provider or the fact that it's a PPO - please keep that in mind.  My prescriptions are $30+... the ones that are covered! 
    We plan on putting DS on DH's insurance, and I really wish I had gotten on his plan last year - I wouldn't be paying nearly as much to have this kid as we are.  We would have paid less for the premium on his than my maximum out of pocket will be without the premium.

  • Hey!  I actually work at OUHSC as well and I just have to Open Access plan (one of the PPO options) and I've personally not had any problems with it.  I personally chose to go with the PPO options just because I didn't have a PCP at the time, didn't neccesarily want to have to find one if the first thing I needed to go see a doc for was like the flu or something, because I don't go to the doc very often, and because ALL I have ever heard about HMO plans, Aetna or not, is the pain of having to deal with the referral system and the PCP thing.  I have no idea personally if either of these issues or anything else HMO related is any less confusing or difficult to work with/around then any other plan available though.  I can tell you, because I work on claims most of the day at work, I have see Aetna respond quicker and in general, better, to the PPO plans they have available.  But, don't let that discourage you from the HMO plan if that is what would work better for your own coverage needs.  The accounts I have seen where the Aetna HMO plans could seem "difficult" just do the patient and what they were being seen for...I will tell you as OUHSC employee, as expensive as the aetna plans are after what the university pays for, unless you just absolutely need more coverage or it's for a spouse/child, I woudl just sign up for one of the plans that is completely "free" to you.  As to whether you choose the HMO or PPO plan, I would honestly just look at your health history and things you know you are FOR SURE going to have to have done during this year of your coverage and then pick the plan that is best overall.  I know emergencies can happen and you may not have the "best" plan for that, but base it on what you KNOW you will have to have done as far as routine checkups or any planned surgeries.  And, the great thing about OUHSC, regardless of what plan you have now, you'll have the opportunity to pick your plan again or change it to a different plan at least once a year because you have to do the paperwork over every year..
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