lovethepirk
New Member
- 1
Hi, thanks in advance.
I'm self-employed and I use the ACA/obamacare to get my health insurance.
I'm looking at two almost identical plans for 2016 except one is slightly more expensive as it is an EPO and the other is a HMO.
I rarely go to any doctor and I do not have a primary care doctor which is needed inside an HMO to see a specialist, but the EPO doesn't have this requirement...I like that b/c if I have the sniffles I just bare it out, but if I'm really messed up(ie somethings torn/broken) I just want to swing into a specialist immediately.
My confusion rests in getting an MRI tho...in an EPO if you know you need an MRI and you must get prior/pre authorization how in the hell do you get the authorization? Can I just call my provider, get a form, and bingo, I get authorized or denied based on what I tell them? Or inside an EPO do I just bypass my primary and get a recommendation from an Orthopedic doctor and then send that to the provider to get the prior authorization?
Thanks.
I'm self-employed and I use the ACA/obamacare to get my health insurance.
I'm looking at two almost identical plans for 2016 except one is slightly more expensive as it is an EPO and the other is a HMO.
I rarely go to any doctor and I do not have a primary care doctor which is needed inside an HMO to see a specialist, but the EPO doesn't have this requirement...I like that b/c if I have the sniffles I just bare it out, but if I'm really messed up(ie somethings torn/broken) I just want to swing into a specialist immediately.
My confusion rests in getting an MRI tho...in an EPO if you know you need an MRI and you must get prior/pre authorization how in the hell do you get the authorization? Can I just call my provider, get a form, and bingo, I get authorized or denied based on what I tell them? Or inside an EPO do I just bypass my primary and get a recommendation from an Orthopedic doctor and then send that to the provider to get the prior authorization?
Thanks.