Insurance Mazes

Just as there are many different flavors of ice cream out there, there's a whole variety of health insurance options to choose from, especially if you're fortunate enough to work for a large employer that can absorb most of the cost of your monthly premiums. I was discussing insurance options with a friend today, which made me reflect back on the various insurance options we'd held throughout the years.

My first foray into the world of health insurance was when I was in grad school, and the only option was to purchase the university's grad student health plan, which was a PPO.  I didn't really think much of it until after Todd was born. Suddenly, I learned the true meaning of "co-insurance" as I sorted through the mounds of hospital and doctor's bills that arrived afterward. Some of it was no surprise-- circumcision was not covered, so we were on the hook for the entire cost of it. Some of it was expected and paid begrudgingly, such as our percentage of the hospital stay cost. And then there was one bill-- the anesthesiologist's, where I owed an out-of-network share of the bill instead of an in-network portion.

This puzzled me, because I was IN Cottage Hospital, which is IN the network. Well, turns out that even though the hospital was in-network, the anesthesiologist's medical group was not. So the cost of the services he rendered (administering my spinal injection) was "out of network", and charged accordingly. The closest anesthesiologist in our network? Santa Maria. Yeah, don't ask. I still haven't figured that one out.

After Todd was born, we put him on Healthy Families, California's insurance program to cover infants and young children of low-income families. As two starving grad students, we definitely fit the bill, albeit at the high end of the salary limit. This was an HMO, and it was virtually pain-free. All I ever had to worry about were a minuscule monthly premium, small office co-pays, and that was it. No more getting bills in the mail. No more sifting through them and arguing about weird charges. If we needed a referral to a specialist, it was no trouble getting one from his pediatrician.

When we started working for Citrix Online, there was no HMO option. Instead, there was an EPO, which was a hybrid between an HMO and a PPO. It was like a PPO in that you could see any specialist you liked without a referral from a PCP. And it was like an HMO in that they only covered in-network costs. That was really convenient to have, and we kept our family on the EPO even after I started working for UCSB, where there were even more insurance options available to employees.

But then Citrix's provider raised the premiums for next year, and by quite a bit! So now we're going back to the HMO through UCSB. UCSB does also have an HMO/PPO hybrid, but in a different way: it's like an HMO in that you need a PCP and referrals to specialists, but it's like a PPO in that it provides some coverage when you're out-of-network.

After the myriad of experiences with different types of insurance plans, I decided I'd rather stick to the good old-fashioned HMO, and not have to worry as much about bills and costs as I would under a PPO.

And let me just end this post by expressing how grateful I am to 1) actually HAVE good health insurance, 2) have an array of choices (PPO, HMO, EPO, Hello!) available, and 3) have it all through employers that make it more affordable for us.