Insurance Issue - combining hmo and ppo

[jiniani]

Not sure if this is the right forum to ask...

I've Kaiser (HMO) and my wife has a PPO plan. Kaiser doesn't pay for any treatment outside of their hospitals.

If I want to go to a hospital of my choice for the surgery would my wife's PPO pay for it? What is ur your experience in this kind of situation?

thanks in advance.

 

[PamO]

Are you on your wife's plan now? I assume not because you indicate you're with Kaiser.

You can go on your plan as long as a qualifying event occurs. You can't just "switch." This could be loss of coverage for you, your coverage renewal is too high, etc., etc. Then you could go onto her insurance. But, make sure you don't have any lapses in coverage or your surgery could be disqualified because it would be "pre-existing."

Depending on her coverage, it may also be considered pre-existing, because you're being treated now. Look into if her coverage has this type of clause.

 

[jiniani]

I'm on her insurance as well. And we both work for different companies and never had lapse of insurance.

I'm not under being treated right now. I'm just a candidate for surgery in shortwhile.

Personally I prefer to go with PPO (to stanford) not with kaiser. We both are in each others insurance. The question is , can I choose to do surgery in Stanford through PPO and not go with Kaiser?

thanks

 

[Lynlw]

I didn't have kaiser but my husbands insurance was better than mine his is a PPO and mine was an HMO, it was a hassel to get things done when mine was my primary insurance , I don't know if this is an option for you, but I dropped my insurance from work, and just used his, Lyn

 

[Georgia]

If you're covered by both, you can comply with the requirements of the PPO. Kaiser will be billed first (as it's primary); when Kaiser rejects it, the PPO will be billed and will pay under its contract. You need to be VERY sure that you're covered under both; and I'd talk to the PPO people up front.

My husband and I were in the same situation for a while, and we really had no problem with this arrangement.