health insurance

September 20, 2006 11:57 AM

Question for New Yorkers. I was thinking about switching from Oxford health insurance plan to the mid-level HIP plan. I can save a bundle. Is HIP just terrible though? Anyone have any thoughts, seen any rankings?
posted by dearleader to health & fitness (4 comments total)

I had both Oxford and HIP (at different times) in NYC and although there are a million different variables here, my general impression was that HIP was better if only because it was accepted by more doctors and specialists. In fact my wife had to change doctors because hers stopped accepting Oxford altogether. My HIP plan did not require referrals and had moderate copays and prescription costs, but I never filed a hospital-stay claim so I can't speak to all facets here. If I were you I would not only compare the monthly premium costs but also the annual maximum out-of-pocket costs and the annual deductible. Good luck.
posted by mattbucher at 1:47 PM on September 20, 2006

Nope, HIP isn't terrible at all. I mean, all insurance companies are pretty nasty and all of them are a lot more concerned with making a profit than providing you with medical care.

But, HIP's crappy reputation comes from its old model of operating. Back in the day, HIP used to run these HIP Clinics where you went to get treatment.

They changed from this model a long time ago and now have a variety of different plans that are standard HMOs, PPOs, POSs, EPOs, etc. You name it. I believe they even have a plan called something like "HIP Classic" that has a very low monthly premium and uses the old clinic model. Their network, as mentioned above, is pretty large and they've got plenty of good doctors and bad doctors.

On a quick side note, its actually mildly illegal for someone who isn't an insurnace broker to tell you whether one plan is "better" than another plan since it opens them up to all sorts of liability risks.
posted by lucidreamstate at 2:39 PM on September 20, 2006

On a quick side note, its actually mildly illegal for someone who isn't an insurnace broker to tell you whether one plan is "better" than another plan since it opens them up to all sorts of liability risks.

Wow. I've actually heard the exact opposite. I have a hard time getting a straight answer out of anyone in any HR department about which plan is "better" since each depends on your needs and they are loathe to give you advice that may be incorrect. Do employers retain "brokers" to advise employees of which insurance plan to elect? I've never heard of it. Are you talking about calling the insurance company and asking "should I stick with your plan or switch to HIP?" The only straight advice I've gotten about health insurance plans is from friends and family members who've used the darn things.
posted by mattbucher at 2:53 PM on September 20, 2006

On insurance brokers:

The laws in most jurisdictions say that only people licensed by the state as insurance brokers are permitted to give you advice about which plan is "better" or which one you should buy. Brokers aren't employees of the companies whose insurance they sell, and they generally aren't part of a company's HR department, although some companies hire brokers as consultants to help employees navigate the benefits system. They have to take a state licensing exam and fulfill other requirements that are supposed to ensure that they know enough about insurance to give you good advice. As with many occupational licenses, it's basically a cartel that helps protect existing brokers from competition and helps draw business their way because it's the only place people can get real advice.

The people in your HR department aren't insurance brokers, nor are the people who sell insurance for a particular company. That's why neither of them can say "X plan is better than Y plan" without running into problems. Moreover, if you call HIP, they're never going to tell you "HIP Plan A is better for you than HIP Plan B," because if you developed some medical condition down the line for which B would provide you better coverage than A, they worry that you might sue them for giving you bad advice.

Non-brokers can legally tell you "here's what happened to me when I had X plan," or even "I found X plan easier to use than Y plan," because that's a report of subjective experience, not buying advice. Your HR department probably won't even do that, because again, they're afraid of liability if they advise you to pick a plan that later turns out to be not enough coverage for you.

IANAL, IANAInsuranceBroker
posted by Amy Phillips at 3:09 PM on September 20, 2006