HMO:  Health Maintenance Organizations (HMOs)
were a great idea when concieved, over 25 years ago. The basic principal was to promote good health by encouraging its participants to visit their doctor by charging only a nominal fee. This way, people would have more regular checkups, and the medical community could catch any problems in their infancy, before they escalated into more serious conditions. The HMO system seemed to work well for a while, but it has now turned into an administrative nightmare.

HMOs tend to charge a higher premium than PPOs. There are co-pays for doctor visits, hospital and emergency room, prescriptions and diagnostic tests, but they usually do not have deductibles or coinsurance payments*. Under this system we must be assigned to a primary care physician who must be part of the HMOs network. Often time the list of doctors in the HMO network is quite limited, forcing us to leave a doctor with whom we have had a relationship for years. We must visit this doctor in order to get a referral to any specialist (who must also be in network). Even if you know that you need an orthopedist (or any other type of specialist), you must waste you valuable time in the primary care physician’s office and pay the applicable co-pay just to and garner the referral that you already knew you needed. Once you see the specialist, you must pay another co-pay (usually greater than your primary care physician’s).

Cost and convenience aside, the single most alarming characteristic about the HMO is how their doctors are paid. The primary care physician is given a monthly allowance for each patient assigned to him. This means that whether you visit him 10 times this month, or not at all, he makes the same amount of money. Where is the incentive to schedule follow-up visits? In addition, at the end of the year the primary care physician is given a bonus based upon the profitability of the HMO. Each time he has given a referral to a specialist, a part of his bonus goes to the specialist. This is not at all to say that there are not plenty of altruistic physicians, who have the patient’s well being foremost in their minds. But, on the off chance that a doctor may put his finances ahead of your care, is this really a system in which you want to participate?

The same HMO system is an option for those participating in Medicare. The difference being, that you could assign your Medicare premiums to the HMO, so there was no additional premium cost to you. Recently there have been substantial changes to HMOs. They are charging Medicare recipients a premium, reducing plan options, increasing co-pays, and in some instance replacing the fixed dollar co-pays with a co-insurance percentage which may carry unlimited potential risk.
So long as you remain healthy, or need only routine care HMOs work well. However, we at Golden Gates Agency refuse to sell a product that we would not want to protect our selves or our families, so, we do not offer HMOs.

PPO: Preferred Provider Organizations (PPOs)
is mode of health care delivery through which an insurance company manages costs by negotiating price discounts with health care providers in exchange for their business. The network of physicians and hospitals provide the plan participants with discounted rates for their services. Individuals covered by a PPO are also allowed to use providers outside the network, including specialists, for an additional expense. You select the amount of money that you are willing to have at risk through deductibles, coinsurance (and sometimes co-pays), then the balance of your medical expenses are paid by the insurance company up to the lifetime maximum. Your premiums generally decrease as your potential total liability increases.

Golden Gates Agency has selected only the most reliable companies with which to entrust your insurance. We do not feel that HMOs provide the quality medical care we ourselves would like, so we don’t offer them to our clients. All of our PPO plans use Great West PPO network, which includes nearly all hospitals in the Maricopa County (even Mayo Clinic) as well as the vast majority of doctors. You can choose your own doctor- no referral necessary. Coverage is both in and out of network. All emergency treatment is covered as if it were in network. Also, you will not lose coverage if you move out of state. We chose Express Scripts as our prescription service, offering a nationwide pharmacy network, and preferred pricing. Many options include: accident, maternity, and life insurance benefits, a variety of deductibles, co-insurance percentages, and stop losses. Most of our Major Medical Plans have $5,000,000 lifetime maximum per person, with no limit on individual instances.