I would have taken her to an eye Dr. Not my PCP

Gerryann- are you certain about this? My understanding is that for a true emergency you do not need a referral. Go to the ER and notify your plan/PCP as soon as possible after treatment. I would conclude the eye injury was an emergency and qualifies for the exclusion.

WAIT! The correct answer is, "It depends on terms of YOUR medical insurance."

The Villages Health System is not an HMO. It is a business that offers the services of health care providers.

An HMO is an organization that provides managed care for health insurance, self-funded health care benefit plans and individuals, and acts as a liaison with health care providers on a prepaid basis.

Gerryann, an HMO may require a referral from a PCP to see a specialist. If you have insurance from an HMO, you are in that boat.

Other insurance companies do not make that requirement. Medicare is a prime example. Also, if you have insurance from a PPO, you probably can see a specialist without a referral.

Correct - except in any case involving a true emergency. Then it is Katy bar the door. You never need a referral in the case of an emergency - HMO, PPO, etc. - just go to the emergency Room. Most likely they will have a specialist of the type you need on call.

I've been happy with the Villages Health system at Colony. When I was unable to get a same day appointment with the doctor I saw the PA and liked the way she communicated and have confidence with her. A strength of the system is the medical records technology. I got lab reports by email today. You can also email a request for a prescription renewal. I am concerned about a recent editorial in which the Villages Health spokesperson indicated that Medicare Advantage patients have same day appointments. We are changing to a supplement plan next year (which of course is more expensive) and I don't want to be a second class citizen.

To be clear, we went to ER they treated her and told us to Follow up with opthamologist a and primary. We have done so on our own. Just commenting that villages health care is not quite the Marcus Welby they led us to believe .

Of course in an emergency you always go to an emergency room or urgent care regardless of what insurance you have. I would never imply that you wouldn't.

I believe that's the villages health care is still defined as an HMO. They are just paid differently than your usual HMO. They are salaried.

The Villages Health is an organization of medical providers (i.e. doctors, nurses etc). It is not an HMO, which is a type of insurance sold by an "insurance company". What you may be confused by is a United Healthcare Medicare Advantage HMO which is called something like 'The Villages Medicare Advantage HMO by United Healthcare'. The Villages Health accepts and promotes this plan. However The Villages Health also accepts other United Healthcare Medicare advantage plans such as "PPO's"

Ok, now I understand. However, you still have to use their Drs, correct? ......and can you go out of network if you want?

More concerning is neither Shands nor Moffitt are in network.

We have been with them before the beginning through
Family doctors of Bellview. We are at Santa Barbara and love their staff. We've been through emergencies without issue. I looked at the program offered by TV and quickly discarded their plan. No one ever gets something for zero premiums. Read the fine print. I was also less than impressed by their sales person at Brownwood. I felt he simply wanted to close the sale, not offer what I needed. If you travel or summer in you home state you may be without coverage. We head back to NH for a few months each summer. Only 3 counties have coverage. But if I had not asked, he would never have told me. Also check out the day rate for hospitals. There is a 5 day copay per incident not per year.
I chose UH plan F as my supplement. It's readily accepted at VHS as was my NH state pension health plan. You don't have to be part of the VHS plan to receive services.
Buyer beware. Nothing in life is free!

Exactly. My concern is belonging to any plan that designates who you MUST see. The only way folks that are "so happy" with the villages plan or any "free" plan for that matter will be when they have a devistating illness and they are not allowed to see Drs that might help.

No matter what plan you have, for some cost, you can always go out of network. It might cost you a 20% out of network fee (typical PPO plan), or you might have to pay 100% out of your pocket (some HMOs). For a true emergency there will typically be some moderation of your potential out of pocket expense.

If you have the HMO you would see your network doctor who could give a referral for a network specialist. If you have a PPO, in most cases you can pick your own network specialist without a referral. In either case, you can go out of network at an additional cost.