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[IP] RE: Joy's question on HMO/PPO coverage

> First, I would assume that diabetes is a pre-existing condition.
> Therefore most of the plans require a 1 year period before coverage for
> these conditions starts.  The other plans are HMO's or PPO's (YIKES!)
> What kind of fight can I expect from them? Is there any way I can find
> out if supplies will be covered before I pick a plan?  Are Endos
> considered primary providers????  I am just a little nervous about how
> all of this works, I feel like they are holding all of the cards and i
> am just here in the dark!!
> Thanks,
> Joy Spoljaric


I wouldn't be so quick to condemn HMOs or PPOs. I realize there's a lot of
negative press that they've received lately and a lot of it is justified but
that doesn't mean that you can't get decent healthcare coverage.

My experience with Cigna PPO has been very positive. I have had several
insurance carriers over the last 10 years and I like Cigna the best out of
all of them. I have had this same Cigna plan at a previous employer and my
experience there was positive also. I always get funny looks at the doctor's
when they ask me who my health care provider is and I mention Cigna. I'm not
sure if they have a bad rep or what but I'm not complaining.

Even with the pre-existing condition clause, they covered all of my
pharmaceuticals for multiple daily injections under the normal $5 copay and
covered my endo visits with the normal $10 copay. My endo is considered my
primary care physician. They covered my pump at 100% after the pre-existing
condition clause had expired. I haven't had to order supplies for the pump
yet so I can't comment on that but I've got both fingers crossed in the

The one time I was hospitalized in 23 years of diabetes, I had HMO coverage.
A friend dragged me into an emergency room DKA with no phone calls to the
HMO, no insurance registration at the front desk, nothing. The HMO covered
the entire thing (in excess of $2500) at 100% with no questions asked. Maybe
I've been lucky. I'm thankful that I haven't had a bad insurance experience.

I think if you do your homework, you can make a choice that will give you
years of reasonable service. Good luck with your new employer.


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