As some of you know, my son suffered an elbow injury in January, likely a torn ulnar collateral ligament that will require Tommy John surgery. Since that time, I've received quite an education about the differences of insurance plans and the importance of having the right one if you want your son seen by the best docs for his injury, not just the best guy his primary medical group has on staff.
Like so many who visit these boards, we have HMO coverage. It's less expensive for monthly premiums and the deductibles are lower too. The down side is that you have to use the doctors in your primary care provider's group, unless they don't have a doc qualified to do the procedure you need. If that happens, they'll send you to another medical group that they are contracted with, and you'd better hope that someone in that group is qualified.
What we have learned is that not a single orthopedic surgeon in our primary physician's medical group has ever performed a Tommy John procedure. The group they want to refer us to has some excellent orthopedic surgeons, but only one of them has TJ experience, and he's only done two of these surgeries. We have also been referred, through some wonderful people associated with an MLB club, to an outstanding surgeon in San Francisco who has done a large number of TJ surgeries, and operates on professional and college baseball players as a regular part of his practice. Certainly, he's a good enough doc for my son, who still hopes to play juco baseball next spring.
At this time, we are wading through the mess that is managed health care. What I've learned over the last two months, and wish to share with everyone here is that: IF we had a PPO - Preferred Provider Organization for our health insurance, my son would most likely have already had the surgery, and with the Dr. we want to perform the operation. Monthly premiums for PPO coverage are higher than HMO premiums, and the deductibles are higher too. When you don't have many medical needs, or any attention that is required is for fairly minor needs, an HMO is a great way to go. However, if you or more importantly your kids need something major, a PPO can be a much better way to go, especially if you want to have a say in who operates on your kid.
We expect to eventually get the surgery performed by the surgeon we want, but have been told to expect the "process" to take about 2 more months, and require a couple visits to doctors who'll have to decline to do the surgery because he still aspires to play college baseball. To say this has been time consuming and frustrating would be an understatement. About the only good thing I can say about our HMO coverage is that it isn't with Kaiser Permanente. There is another local kid who's also torn his UCL and Kaiser has been an absolute nightmare for him. They have a surgeon who's never done a single TJ surgery that is insisting he's qualified to operate on this kid, and won't agree to refer him out of group for the surgery. If that kid has the operation by this surgeon, he's quite likely done playing baseball.
When your health insurance plan options are given at work, I suggest you give strong consideration to which type of coverage will best suit your kid's needs if they require a major procedure. I will be switching to PPO coverage at the earliest opportunity, but unfortunately it won't be until December when we have our next benefits change period.
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He had to get stitched up after a collision, I didn't ever think about checking into seeing if your insurance would pay it, I just reached into my pocket for the deductible. 
