Was the PPO a big mistake?

So, I call today to get more pods and they tell me with my new insurance I pay full price until I meet my deductible…wtf? How am I supposed to have $2200 to get my pods :frowning:

YIKES! Your deductible is $2200? Were you on an HMO before? When I switched from HMO to PPO, I chose the top/best plan, even if it was more expensive, because the coverage was usually much better. But, nowdays the coverage is so bad with any insurance…they make it almost impossible not to end up bankrupt!

I don’t know if its too late to change your enrollment in a program like a flexible spending account (FSA), but that’s usually the best way to pay for any insurance deductible. Just beware that some plans may have a DME (durable medical equipment) deductible that is separate from both the pharmacy deductible and the healthcare (e.g. doctor’s care) deductibles. The specifics are unique to each policy.

my deductible is 3500, and I was on an HMO. But nobody told me I had to pay out the full deductible right away before any cov.g. I understood it to be that I would pay 30% up to my deductible…I am such an idiot.

But, if I just started, and haven’t paid into that yet, I have to pay the entire 3500 deductible before I get any cov.g?

The insurance we’ll be starting on in April is $800! Can you believe that! UGH!

oh yeah, I pay 850 a month to have insurance that apparently doesn’t take effect until after I pay an addtl 3500. I may have to get a different job just because of this. :frowning:

Your deductible is 3500 or your out of pocket max is 3500? The full deductible is due before the insurance picks up any other part of the bill. But, that is really high for a deductible. Dave is right, it’s usually $250-$500. did you call the insurance company? I’m sorry you are having to deal with this! Insurance sucks!


They told me it would cost $2200 for 4 boxes of Omnipods, and I can’t remember if that included DexCom’s too, and that until I paid $3500 I was responsible for the entire bill. Once I have paid out $3500, then I will “only” be responsible for 30% of the invoice.

oh yeah, my company pays for my cov.g 100%. The addtl. 850 a month is to add my wife and son…

MAN! I don’t know what to tell you other than i’m sorry :frowning:

Maybe your doc can give you some samples until you can create a plan. I hate how they expect you to just shell out that kind of money! An FSA is a great idea for next year!

Start lobbying your congress rep/senator to vote for the health care reform.

This has nothing to do with healthcare reform it’s that he has the PPO not the HMO. My Company gave us 2 choices in the new year one was a PPO and the other HMO/ EPO. One thing my employer did was an online comparison of both you added in your what your costs are and it gave you the savings. I pretty much paid the same saving 100 bucks for the year on the HMO/EPO but if I went with the PPO I would have to pay 2500 to start… right out of pocket before coverage would be 100%. HMO costs more per month every month for better coverage but no out of pocket except for small co-pays. PPO is for healthy people that hardly go to the Dr it would be cheaper for them to pay out of pocket for one to two visits a year. With a chronic condition such as D it gonna cost you no matter what. I would go back to the HR people that presented this to you and state they didn’t educate you enough on the costs associated. Ask them to show you a comparison fight with them see if they can switch you it’s worth a try. Sorry this happened to you but like everything in life you really need to look at the fine print if it’s going to hurt you and your family.


One aspect of flexible spending plans is that you can be reimbursed for qualifying expenses long before the money has been deducted from your paycheck. Really! You can use up the entire year’s worth of FSA money in January if you want to. That’s the risk for the employer. If you quit or are fired in February, let’s say, they are on the hook for your entire January claim even though you’ll never contribute anything more to the FSA plan.

So, you may have to pay the entire deductible before you get any coverage, but you can claim those expenses immediately.

When I ordered my pump, they required me to pa 20% before they would ship it out. Maybe you can pay a portion of the cost and then be billed for the rest?

I think things used to be this way, the shipped things out, then sent a bill later. Now, with money being tight etc, I think they are getting stiffed, so they are demanding payment upfront. So sad.

I actually had to PREPAY! Yes, prepay for a necessary surgery back in October. The whole amount! I have had lots, and lots of surgeries in my life, and that was a first.

Please remember that not all companies offer HMO options! I live in Nevada and there are few HMO’s here that no company we’ve worked for offers!

exactly, my company is based in San Francisco, CA and I work from home in Colorado so I get the expensive crappy coverage option. I called my boss and told him about my concerns, I mean I have to have insulin, and he is going to speak to the CEO and get a resolution. I’ll keep you all posted, thanks for the loads of info and support.

We’ve always had HMO and still do but they just changed it from under us (same ins, they just changed the rules) . We used to just pay co-pays now we have to spend $2300 before they pay for anything! It’s a flexible spending account (FSA) so money goes in every pay, pre-tax and we have a charge card to use for all medical expenses problem is, no money has gone into the account yet and I’ve had 4 Dr. appts and 2 prescriptions! I’m having everyone bill insurance, then it’ll be rejected and then they’ll bill me. Hopefully by that time there will be some funds in this account.
Good luck! I would definitely talk to HR and see what can be worked out.