IS WESTERN HEALTH ADVANTAGE AN HMO OR A PPO?

We get the question almost daily…

Is Western Health Advantage an HMO or PPO?

The short answer is this.

Western Health Advantage is traditionally an HMO

Now for the long story.

WHA may be one of the best-run, regional HMO’s in California and they’re part of a trend we’ve seen since 2014 and the ACA law went into effect.

Regional HMO’s are getting high marks from their members…much better than some of the dominant Statewide carriers available.

If you want to jump right to a quote, click below or read below for WHA’s advantages.

Let’s look at Western Health and why it makes the HMO model work!

Western Health Advantage’s HMO

First, a quick refresher on the HMO model.

HMO stands for Health Maintenance Organization but really it boils down to this.

The HMO model shares financial responsibility for the member’s care between the insurer and the provider (doctor/hospital).

This may end up being the model that works for this reason…

With a PPO, there’s no incentive to manage care from the provider’s point of view.

You can read this two ways.

Our jaded side might say, hey, the HMO will not approve more expensive care.

Here’s the deal.

If more expensive equaled better outcomes, that might be a real concern.

Let’s look at a very real example where the opposite was true and I more than paid the price.

Long story short…I severely scratched my cornea playing basketball and it would periodically re-tear at night. It was horrific and went on for months.

I saw a doctor who prescribed surgery (at the surgi-center he co-owned) to remove the cornea. Unbelievable pain and a few $1000’s later.

The issue continued. In-office cornea scraping.

Issue continued. I had an appointment for a third surgery. He came very highly regarded with prestigious degree so I agreed.

I stumbled upon info on Wikipedia (of all places) where it described how a simple antibiotic has the strange affect of aiding the cornea’s ability to adhere when repairing.

We’re talking amoxycilin. I asked the doctor about this and he got skittish with a reply of “yea, we try that to help with the surgery recovery but there are some side effects with upset stomach and the like”.

Really. Upset stomach and you’re scraping my cornea off!

Any way, I took the medication (prior to surgery) and it cured my eye issue. Almost immediately.  No surgery needed.  6 months of hell ended.

So much for long story short but here’s the deal.

With my PPO plan, the doctor could prescribe almost any medically feasible course of treatment.

I paid dearly both financially and in terms of hardship.

With an HMO, you try the simple penicillin first. If that doesn’t work, you look at surgery.

Now, that doctor was at best unethical but the HMO model helps to tamp down on excessive surgeries, etc.

You can get much more detailed info on the HMO versus PPO consideration here.

Back to Western Health Advantage’s HMO

WHA Does HMO Well!

There are two primary considerations then when looking at the Western Health Advantage HMO (Versus a PPO).

The HMO network

What doctors and hospitals do we have access to?

That’s critical with any HMO (or PPO for that matter).

This may speak to why regional HMO’s are doing so well.

Western Health Advantage has partnered with some great providers!

Here’s a quick list but it’s clear that they have picked some marquis hospitals and doctors:

Make sure to verify that these providers still contract.  You can find the provider directory through your quote.

Since we must stay within a network with an HMO, it’s important that we have a good network!

WHA does that!

The next consideration is member reviews.

Western Health HMO reviews

There’s a reason WHA continues flourish in its chosen areas.

Their members really like them!

Even their doctors rate them highly.

From their website:

You trust your doctor to give you the best care possible and your doctor trusts Western Health Advantage. More than 92% of our providers would recommend WHA to other physicians.

Source: 2015 Provider Satisfaction Survey. 92.5% of providers would recommend Western Health Advantage to other physicians’ practices.

That’s hard to do as a health insurance carrier.

Western Health’s Real Advantage – Pricing

Why consider HMO’s over PPO’s such as WHA anyway?

Pricing!

For a given quote, it’s not usual to find WHA’s pricing 10-20% less than the lowest plan on the market.

Just to day, while quoting an individual’s coverage, WHA was $100/month less than Anthem’s EPO plan (same exact benefits).

In that case, she was quoting an HSA Bronze plan. The premium difference basically meant she could fund $1200 in to her HSA account and not feel the difference.

The WHA actually had more providers in her town than the Anthem EPO plan. EPO is their new PPO. Understand the California health networks here.

You can quickly quote WHA against other HMO’s and PPO’s here:

Individual and Family Western Health (including Covered Ca)
Small Business Western Health Advantage (1-100 employees)

Keep in mind that the benefits are standardized so we’re really comparing networks, pricing, and ease of use with the carrier (i.e. member satisfaction).

WHA HMO Wrap-Up

So we know that Western Health is an HMO.

We know that it’s one of the best run HMO’s with premier medical facilities and providers in contract.

We also know that the savings in premium can be significant.

Finally, keep in mind that we can change plans at the end of each year for individual/family so we’re not locked into a carrier.

We can try the WHA HMO for the year and change at the end of year if we want to.

We’ll get into the WHA versus Kaiser discussion in a later article.

Both are HMO but with very different models.

We’re happy to walk through any questions you have on Western Health, HMO, PPO, and health insurance in general!

Call 800-320-6269 or request your WHA quote below.

We have helped 10’s of 1000’s of Californians across the State make this same comparison.

We’re getting pretty good at it!

Quote Western Health Advantage plans to view rates and plans side by side for both carriers…Free.

Again, there is absolutely no cost to you for our services.  Call 800-320-6269 Today!