Can you pick or own doctor with a PPO or and HMO?

I have always thought that a PPO you could pick or own doctor, and that an HMO you couldnt...now I was told that is not right. Can someone help

PPO= PREFERRED provider organization

HMO= health MANAGED organization

PPO plans generally give you the option of seeing a participating or non participating, but encourage you to see participating at it saves the insurance company money, and often times saves you money as well.

There is a 3rd "type" of insurance refferred to as a regular indemnity insurance. This type allows you to see whomever you wish, and pays the same rate, not matter who you see.

HMO plans require you to see a participating doctor. Usually you have to pick a general practioner as "your doctor" and then this doctor may refer you to specialists as needed. If you see someone other than your assigned doctor, your insurance will not pay.

With both PPO & HMO plans, participating doctors agree to a reduced payment rate, which is why the insurance companies want you to see the doctors on their plan. In adidtion, most HMO's use a capitation program, which means they send money to said dr everymonth, for each patient assigned to his/her office. They get a monthly $$ whether you see them or not, which is why they make is so difficult to get a referral because then they will have to pay 2 or more doctors at the same time. HMO's may have been set up with good intentions, but its really the pits.

you can pick your own doctor with PPO -- you are right !

When I had a PPO (Preferred Provider Network) I had a list of "preferred" doctors to choose from. If I chose a preferred doctor, I could see the doctor for a low copay fee. If I chose a non preferred doctor, I had to pay for it our of pocket, until I met a deductible. It is my understanding that an HMO works the same way, as they want you to see a preferred doctor, the difference being, you have no choice about seeing a non-preferred doctor.

You can pick your own BUT you will have better coverage if you select one from the PPO or HMO list. I know with my insurance, the HMO list is fairly short but I get to pick. The problem with the short list is that the doctors are usually very busy and I sometimes have to wait longer to get an appointment.

You can pick your own MD in both- the exception is with HMO you have to stay with your pick until you notify your insurance carrier you want to change.
Both must be in your network!

yarmiah's answer is very good and complete.

You can see any doctor with a PPO as long as he is a provider. Referrals are not usually needed to see a specialist. For an HMO, you can choose from a list of providers or just let the insurance company pick one for you. You just have to continue seeing him or you can switch at the beginning of the month if you need to change. Referrals are needed for most specialists. Most people like to choose their own doctor.

Regarding the answer above.. a PPO usually costs more and usually has a deductible. You could also have a copay. The HMO actually saves you money by having a set copay and the rates are cheaper.