[cathybee1]

Plus of a PPO is that you have wide flexibility of doctors and facilities. Most university hospitals are part of a number of PPO chains.

If you go to a "preferred provider" with the PPO, the rates they will charge the patient is negotiated with the insurance company up front, and you are not required to pay more than the negotiated amount.

The billing is generally done by the provider, and by the time you get the bill, insurance has already paid its share.

Minus is that you have many more out of pocket costs than with HMO's. Besides the premium, there is generally a co-pay for everything. The co-pays can be a percentage of the bill or a flat rate depending on the type of service.

We have a PPO and are generally satisfied with it. What is good with ours is there is what they call a "catastrophic" limit, which is the maximum out of pocket expenses you must pay each calendar year. If you have a choice of PPO's, check the catastrophic limit. IMHO, it is worth it to pay a higher premium because treatments for this disease are expensive. Bruce was diagnosed with MDS in June, he hit the catastrophic limit (of $5000 out of pocket) in August, since then he has had no co-pays.

Nonetheless, this is a lot of money to suddenly be faced with paying. But it is possible to shop around. Bruce's weekly Aranesp injections are billed to insurance between $4000 (85 miles away) and $8000 (22 miles away) a shot. His co-pay was 10% this year. Bruce is driving farther to get his shots because they are half the cost.

We have also seen differences in costs between providers based on how they bill the charges to insurance.

His transfusions have been running about $2000 with his copay $200.

It is too bad that patients have to deal with all of this. It has been quite an education. We have based some of our treatment choices on what providers charge and what insurance would pay.

If you are older than 65, Medicare will pick up more of the out of pocket cost. Unfortunately, Bruce did not opt for Medicare because he was so healthy before this and had good health insurance. He has applied and it will go into effect next July.