Treatment Options in Jacksonville, FL & Florida Blue

[Livvies Mom]

I just posted on "Your Story" and I have a few questions I am posting separately:

Livvie (15) has just been diagnosed with Crohns at Nemours Jacksonville. Is Nemours a good facility or are there other options we should consider?

Even if Nemours has an excellent program, I may seek a second opinion just to get a different perspective, any suggestions in Northern Florida?

Insurance Open Enrollment is coming up. We have Florida Blue HMO insurance now, but could change to PPO. The PPO premiums, copays and deductibles are MUCH MUCH higher than the HMO. The HMO covers Nemours, but Mayo Clinic only accepts the PPO. Reasons for/against upgrading to PPO?

 

[DanceMom]

We are at Nemours Orlando and have been very happy there. We got our second opinion at Egleston in Atlanta at the advice of our GI.

 

[my little penguin]

Medically complicated means lots of appts with different specialists
Most crohnies need to see opthamalogy once a year
Gi every 2-3 months for the first year or two .
With each visit a referral needs made etc ...
Same with each test
We have a ppo since it's easier to hit max oop and have the rest of the year free
Plus not wait for referral when things are needed quickly.
More than once when DS was bad the Gi wanted him in the office that day or the next morning .

 

[Livvies Mom]

Great advice thank you both very much!

 

[Brian'sMom]

I would pick the one that gives you lots of options. This disease can be complicated and expensive. We've met our deductible every year the past 4 years in in the first few months! And we've been to Mayo Clinic in Minnesota. I love having that option. Good Luck with your decision.

 

[Clash]

I would go with the ppo as well. We have BCBS of Illinois PPO. So no referrals we just choose our specialist and go. This is good since he sees a GI, rheumatologist, ophthalmologist etc.

I have heard good things about Mayo in Jacksonville but it wasn't related to children or IBD. Hope you find a great place for second opinion.

 

[Livvies Mom]

Thank you so much for your suggestions. I have spent a few days learning the details about the two plans we have to choose from. In our case, the PPO premiums are only $1000 more, yet they pay for less. Deductibles are $600 HMO vs $1500 PPO (which isn't an issue since I'm sure we will reach that anyway), Coinsurance 30% HMO vs 50% PPO, but the biggest concern is out of pocket max $5000 HMO vs $12000 PPO.

The only thing our PPO offers for the additional cost is a larger network that includes Mayo Clinic. The covered conditions and treatments is the same for both plans, and there is no need for in-network specialist referrals with either. At this point I am committing to Nemours in hopes that they will provide the care she needs, so we are going to stay with the HMO. Next year we will reevaluate and if we think she would benefit from Mayo, we can switch to the PPO.

Every plan is different, ...I learned a lot from the fine print.