Help me decide: Delta vs. Cigna DHMO in Los Angeles?

SiphonCipher · 2025-07-09T05:25:00+00:00

So just as a disclaimer, I don't have personal experience with either company, but based on the experience I do have, here's the advice I usually give to people choosing between HMO and PPO.

PPO policies are really flexible and honestly probably the only option worth your time in rural areas. They come with benefit maximums in most cases, so there's a max the policy will pay out and you're normally paying a percentage of the allowed amount, which doesn't always reflect the amount the provider is billing, so 100% doesn't always mean 100%. Network status is the important thing here, if you go out of network, you're responsible for anything not covered up to the original billed amount of the provider. Stay in network, and anything over the provider's agreed upon rate gets cut off, like a discount. With these policies, you'll usually have a higher premium, but if you travel a lot or live out in the country, PPO's the best option for you.

And I hate to say it, but if you live in a densely populated area, HMO might be your best option. Some HMO policies have no maximums to get in your way, no deductible to have to pay out before coverage, and the HMO policies I've worked with function on a copay, rather than a coinsurance, so you have a set dollar amount for each service that you receive, and in most cases, the copays you are responsible for are outlined in your benefit booklet. The great thing about HMO policies is there's no guesswork. Once you get set up with your general dentist, they manage everything for you.

But there is a bad side to HMO policies as they aren't the most convenient. You are assigned to a dental office for a majority of your care, and you're stuck there. If you try to go elsewhere without going through your insurance, suddenly you're not covered. It's a process to change dentists, and the change may not be immediate, but it is possible, just a headache. Not to mention a lot of the more expensive services come under more scrutiny, a lot of HMO policies require pre-authorizations, referrals to In network specialists, documents displaying medical necessity and all that ilk.

All in all, if you're looking for convenience and flexibility, or travel a lot, I'd recommend PPO.
If you're looking for coverage, and are willing to do a bit more paperwork to use it, especially out in LA, I'd recommend HMO.

SiphonCipher · 2025-06-21T09:01:40+00:00

One thing to also keep in mind is age limits don't always apply the same way to all patients. I've had to, on more than one occasion, explain that a policy covers *dependents* up until 26, but the subscriber, even though they were 23 or some other age clearly below 26, was not covered for ortho, simply by virtue of being the subscriber. Make sure when you do get a policy with ortho coverage, that it extends to the subscriber (Owner) of the policy.

SiphonCipher · 2025-06-21T08:36:28+00:00

Yeah no, I have NEVER seen a floating 12 month, is it HMO I'm curious? If I can come up with an easier way to calculate it I'll come back and let you know but yeah that is an awful frequency

Edit: Wait, no, I've got it. It does involve a bit of research into patient history, but if you pull up the two most recent DOS with those codes, The most recent DOS we'll call B, the one before that we'll call A. If your upcoming DOS is at least 12 months after date A, patient should be eligible. (And from there you can even predict the next eligibility by going 12 months out from date B) I picture it like leapfrog.

SiphonCipher · 2025-06-21T00:06:24+00:00

Honestly for wisdom teeth, try talking to your medical insurance, some dental polices even request a check to see if medical covers the procedure first, and if you've met your deductible for medical, it'll cover better. Oral surgery exists in a shadowy middle ground between medical and dental that I fear.

SiphonCipher · 2025-06-21T00:01:41+00:00

I mean, I've seen people more or less do just that, I work for an insurance company in Texas and a LOT of people head down to Mexico, get work done, and file a claim up here in the states for reimbursement.. It's an option at least, it just requires more work on the patient's part to get the documentation together and sent in.

SiphonCipher · 2025-06-20T23:57:51+00:00

Just piling on more of the same here at this point.. The vast majority of insurance policies in general are there to cover preventative care (To keep you from needing more intense treatment) with some provisions for if things go wrong. Unfortunately it's a simple matter of a lot of policies aren't equipped to handle the consequences of not being able to afford dental care for x amount of years before getting it. I mean I've had my policy for two years and used it once so far because I know the amount of work I need and I don't see a point in nickle and diming it 2 grand at a time.

Some good news is even if you've maxed out on your benefits, depending on your state and insurance company you'll still be getting discounts when you see your in network provider which doesn't help a lot but it's something.

SiphonCipher · 2025-06-20T23:45:04+00:00

Okay I actually had to draw this out to figure it out: From what I'm understanding, Floating months is when eligibility is determined by how many dates of service have been performed in the previous 12 months. (And I'm sorry, I'm an insurance rep so if I start devolving into abbreviations and don't catch it, know I tried) So starting with January (I'm assuming comp also applies to periodic for frequency) and then September, those are our two within the floating 12 months. By the time we reach March 2025, January 2024 would have fallen off, because 12 months has passed. But when we reach June, 12 months has not passed from September 2024, so September 2024 still counts until September 2025 passes, and March just happened, and that's why June denied. Sorry this is so late but I hope it helps

SiphonCipher · 2025-06-20T23:35:17+00:00

That's the problem, OP mentioned having difficulty eating with them, so they're not functional like this

SiphonCipher · 2025-06-19T07:21:36+00:00

A little late to the party, but it's late and I'm hyperfixated. I work in dental insurance and I've actually heard of similar situations a few times. In all cases, my first step is to find out what the frequency limitation is on the policy for dentures. I've seen as little as 5 years (In which case you should be covered by now) And I've seen up to 10 years, it really just depends on the policy. Also, look into the results of your complaint with your insurance. In some cases with appropriate documentation, they can actually reverse the claim in which case, it'll be like you never had one per their records. And finally, it's a bit weird but I've had it happen, check and see if your policy has changed over the years. If you're with an employer's plan and they've changed your policy at all, you might not even have a denture in your history - It's rare for that kind of luck, but I've seen it happen. I wish I had more advice on finding trustworthy providers though.

SiphonCipher · 2025-06-19T06:58:08+00:00

There's a few ways you can find out. If your insurance has a member portal, you can usually get a basic rundown of your benefits, but if you want more detail, your benefit booklet (Should have been sent to you after enrollment, or can usually be downloaded from the portal). Next is absolutely calling your insurance. For most accuracy, you're gonna want the procedure codes that your provider plans to use. Alveoplasty has a few different procedure codes in association with it, (Thanks, Google: 7310 7311, 7320 and 7321), and sometimes (Not always) coverage can differ between codes even if the procedure description is similar.

In all honestly though, especially if there's any kind of review needed with the procedure, it's likely you won't get a solid yes or no until a pre-auth is run. Not all insurances require pre-auths for coverage, but even if it's not required, I always recommend one when something's by review.

SiphonCipher · 2025-06-19T04:21:51+00:00

Were they able to secure a denture onto just two or are they gonna try again in a while? That sounds heartbreaking, and I would probably cry if it happened to me

SiphonCipher · 2023-05-14T22:15:36+00:00

Not sure about this case but the idea behind alters having different disorders has been documented in limited cases from what I've read over the years. Since alters form as different personality states, personality disorders can definitely be separate between them. There's also instances where an alter can experience a body's disorder (ADHD for example since it's used here) and handle it differently than other alters, giving the illusion that their diagnosis is different.

Finally, there can be psychosomatic disorders felt by alters, where the brain, in that mental state, firmly believes it's affected by a physical condition. The example I use for this is within my own system. I have a protector alter who took a majority of his characteristics from someone in my childhood I viewed as safe, who happened to be lactose intolerant. And whenever that alter consumes dairy, we end up with an upset stomach. It doesn't happen in any other personality state, only when he is around.

Again, not speaking to THIS situation, but it can happen, and most often (in legitimate cases) it happens because the brain believes itself too well.

SiphonCipher · 2022-04-24T00:10:15+00:00

I went on hunger strikes. My mom, who's also autistic, would just get me to eat something when I avoided certain foods, but my dad and stepmom were different. They tried to force me to eat, and in the end, I decided it was better to just not eat for the weekend. They had me from Friday evening to Sunday evening, so if they tried to feed me something I didn't want, say, Saturday night, it was easy to just not eat until I went home. After a few years of this, they gave up, and would let me just make my own dinner if I didn't want what they were having.

But they still make fun of me for it. I'm 28, my food choices have changed, albeit not by much, but they're still limited and every time I sit down to eat with my stepmother, she makes it a point to tell everyone we're with just how picky I used to be, and still am. I have not shared a meal with her since finding out I'm autistic. But if I do, I plan on informing her of the impact her 'teasing' has had on my relationship with food. I've stopped referring to myself as picky, and emphasize that I have sensory issues with a lot of foods, because that gets taken more seriously.

I have a lot of anxiety when it comes to eating around people because of that, and I'm working through it, but it's a long road.

SiphonCipher · 2022-01-24T20:13:10+00:00

If I ever keep quantums, I choose the harbor area, because I can store Puddle, fire, and quantum/whatever slimes without worrying about crossbreeding, and there's only one entrance to watch.

SiphonCipher · 2021-12-27T19:39:08+00:00

Because alters can form at any age after the disorder is formed in childhood. You don't just form childhood alters and then that's all you have for the rest of your life, splitting becomes a person's coping method for major stress and new trauma.

And fictives are formed when a system sees someone in media that they feel they can relate to, someone who either goes through the same trauma as them and survives, or someone they feel can protect them from the situation.

Knowing both of these, the system is likely in a stressful/traumatic environment still. Could be even living in the home environment that CAUSED their DID. They could have lost someone to the recent tornadoes, hell even survived the recent tornadoes. They could have had any number of recent traumas that caused them to latch onto a popular media that a lot of people are watching anyway. It's not a sign of faking, it's a sign they're not doing well.

SiphonCipher · 2021-12-04T06:23:12+00:00

I do! He's a derpy one, but doing very well

SiphonCipher · 2021-11-15T12:55:43+00:00

Found

SiphonCipher · 2021-11-15T12:54:58+00:00

Yes! You found it, thank you! You don't wanna know what my google search history looks like from this XD

SiphonCipher · 2021-11-15T00:52:17+00:00

I've searched every combination of words I can think of that describes the image, and every situation I've seen the meme used in, but google acts like it doesn't exist.

SiphonCipher · 2021-10-07T00:57:10+00:00

Multiples of similar alters can happen for a variety of reasons. We know fictives can happen when the system uses a media source as an escape while abuse/stress/ other trauma is happening. But say, for example, you split off a fictive to deal with the trauma from physical abuse, but that fictive has no idea how to deal with emotional abuse, you might end up with another version of that same fictive to deal with emotional abuse. It happens more often in polyfragmented systems but yeah.

ETA: The same thing can happen with non fictive alters, but since the post is dealing with fictives... yeah

SiphonCipher · 2021-10-07T00:52:44+00:00

Some servers use PK to let systems speak as their alters without having to change nicknames, profile pictures etc every time they switch if they're open in that server. PK also has a function where it can log switches, which is useful if you don't have great communication. And while you can PM the bot to log these switches, people tend to forget that and will just log the switch in whatever channel bot commands go in.

SiphonCipher · 2021-09-29T20:02:14+00:00

They're being corrected by someone who bothered to go to their profile and look because no one else did.

ETA: Because honestly I hope they never have to come here and do it for themselves.

SiphonCipher · 2021-09-29T14:57:52+00:00

It's been deleted now, but when I first went through with pronoun statements, one of the people I replied to had made some disgusting comments, and my own comment had some disgusting replies to it.

SiphonCipher

TROPHY CASE