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Comment by BugsJustFindMe | Hacker News Reader

> Now we all have HMOs

Everyone I know (ok, not literally everyone, but more than a few) has a PPO now. Am I in a weird bubble?

No, not at all. I’m not sure what that line means. We all have (access to) HMOs? Not true, but slightly closer to true. They’ve become much more common? A weird way of saying it, but I guess that is what they must mean. I thought maybe it was something specific to the author, like is the audience for the blog specific to Columbia? But I don’t think so.

The meaning of the line is pretty clear? It is a rhetorical flourish not to be meant taken literally. The author obviously just means "now they are widespread".

"Back in the day HMOs were basically non-existent but promised cost containment, among other benefits. Now they are widespread but they didn't deliver on any of their promises."

Quick google suggests that while more people use HMOs than PPOs, it's not a majority. My job offers both, but the HMOs are only available in a few states.

Or you don’t live in California so you can’t get Kaiser? If you in California it’d be crazy to use anything else but Kaiser.

You're correct.

HMO = you have access to one provider

PPO = you can't preferred access (lower patient costs) to one provider, but access to all

> PPO = you can't preferred access (lower patient costs) to one provider, but access to all

Can you fix the typo in this please? "can't preferred" -I want to understand what you're saying, I can't infer it yet.

I think the commenter means "you can have preferred access".

PPO = Preferred Provider Organization. You have a better deductible/coinsurance/copayment for "in-network" (preferred) providers who have negotiated their rates with the insurer (or accepted the insurance company fee schedule). You typically need pre-authorization for elective surgery and advanced medical imaging. You have the option to see someone "out of network" but with less coverage.

HMO = Health Maintenance Organization. Simple version is you don't get to choose your provider, you don't need preauthorizations and you have to go through your designated primary care provider to access specialists. For the most part you can only access providers within the HMO network if you want any coverage.

> you don't need preauthorizations

To be clear, in an HMO you don't need preauthorizations from your insurance but you still need your (not necessarily self-selected) PCP to order care or refer you to a specialist.

Needing a referral (an assessment by a physician that something is medically appropriate) is not the same as needing preauthorization (insurance company agreeing to pay) but in any case hence the following "you have to go through your designated primary care provider".

Many PPOs and public systems work in the same way, that's more about judicious and appropriate use of resources than payment authorization.

Yes, I was just clarifying because PPOs often do allow you to seek out a specialist without a referral, and without requiring preauthorization.

To late to edit, I blame my phone's autocorrect.

It should read...

You're correct.

HMO = you have access to one provider

PPO = you have preferred access (lower patient costs) to one provider, but access to all

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