Comment by Test0129 | Hacker News Reader

Comment by Test0129 | Hacker News Reader

Parent Full thread

> What's baffling is the lack of any sort of help at the hospital and the inability to find a rheumatologist or specialist or just a regular doctor who gives a damn.

I guess this depends on your situation. I've been in and out of doctors my entire life. The doctors that give a damn are generally locked away from you if you're using some sort of state health plan or HMO. I have only ever had luck finding a good doctor by going through PPO. If you can do this, I would recommend it. PPO doctors make far, far more (because it's expensive even to you) but the specialist access is second to none. It took 3 months to get an appointment with an ENT once, and when I switched to PPO my GP had me into an ENT at my request the next week. Then you start the cycle of feeling them out and finding out which ones mesh with your goals.

It's tough, but navigating healthcare is tough. Just avoid HMO insurance and you'll do a lot better (or at least better than baseline).

Would someone be kind, and explain what PPO, ENT, HMO means? Thank you in advance.

PPO is insurance that you pay more for but you can pick the doctors and services. HMO is insurance where the insurance company picks the doctors and services. ENT is a specialist doctor.

https://m.youtube.com/watch?v=-wpHszfnJns&t=1627s

“A terrible guide to the terrible terminology of U.S. Health Insurance” by Brian David Gilbert

ENT - ear nose and throat

HMO - health maintenance organization. It's a type of insurance where you have to get referrals from someone you designate as your primary care provider.

PPO - preferred provider organization. Another type of insurance where some providers are "preferred providers" who partner with the insurance company to offer reduced rates. You don't need a referral to see a specialist, but many specialists won't see you without a referral anyway.

I have no idea what a "PPO doctor" is, I've never heard of a doctor that only accepts PPOs, that's ridiculous. I guess if a referral is required then the nebulous "they" won't refer you to the "good" ones if you have an HMO?? Except, in practice, you end up at the same handful of providers in your area no matter your insurance. I've had both HMOs and PPOs throughout the years, same shitty doctors on both.

It’s not the doctor, it’s the network. What OP was saying is that the doctors in the PPO networks seem to be much better than those in the HMO networks.

> you end up at the same handful of providers in your area no matter your insurance

This is very dependent on where you live and the density of providers. If you live in a small-to-medium size city or smaller, your description is accurate. In big cities, it's not; there is a whole set of doctors who don't work with HMOs at all, because they don't have to. They often are the best, most in demand doctors as well.

PPO is preferred provider organization. You can see specialists easier and have more latitude to pick your providers, assuming they are in the network. ENT is ear nose and throat, also called otolaryngologists, who do sinuses and hearing and throat cancers and that sort of thing. Usually they are surgeons. HMO is a health maintenance organization which is usually cheaper and offers less choice for the patients but also pays for preventative services more but can be bureaucratic if you have a rarer problem. I use Kaiser because I believe in the focus on data driven treatment and prevention, and haven’t had rare diseases yet. We have used them for vasectomy, breast cancer, cornea replacement, and trans transitioning all fine effect. I have a friend whose wife had some standard type of valve replacement and also had a good experience, tho my friend was heavily involved in meeting with the surgeons and consulting on the operation planning. Most people have common problems, so it works well as a first level, I think.

Edit: Kaiser is non profit. There are HMOs which exist primarily as cost control organizations, not primarily committed to health care, so experienced vary

PPO and HMO are symptoms of our terrible US health system. They are focused on cost control, not positive outcomes. Basically they are middle-men between doctors and their patients. They get to approve/deny care choices. They get to decide, ex post facto, whether or not they will pay for healthcare services, medicines, etc.

Here in the US, you can get surprise medical bills greater than $10k USD, due to these organizations saying "nope, not gonna pay for that."

While in some cases, homeotherapy, and similar, this is justified ... in many/most cases, it really isn't. HMO/PPO etc are all about reducing cost of the care, with these organizations funding themselves from driving down the cost of the the service.

Doctors have to hire people to handle dealing with the insurance companies (HMO/PPO/etc.) Its expensive and time consuming to deal with them.

Thanks for the info, I'll see if we can switch to PPO, especially with open enrollment coming up next month. It could be the difference between life and death.

Reply on news.ycombinator.com