If you are or ever have been in the market for a healthcare plan you will most likely come across the term PPO. A PPO is a preferred provider organization. These plans offer a network of healthcare providers for their members to use for medical care at a negotiated rate. PPO plans allow members to see any in-network health care provider they choose without requiring a referral.
More PPO information:
If you choose to join a PPO, in most cases, you will not need to choose a primary care provider. You will be able to use any provider within the company’s network of providers. All your in-network healthcare services will be covered at the negotiated rate. You will also have the option of using out-of-network providers, although they will be covered at a lower rate. It is always a good idea to make sure your provider participates with your health plan in order to avoid receiving a higher than expected medical bill.
In most cases you will have a deductible to meet each year before your medical bills are covered by the insurance company. There is also the matter of co-pays for certain services. Some services will require you to pay a percentage of the total medical cost. These are things you should be aware of, if possible, before you go for medical care.
PPO plans have a number of in-network doctors and medical facilities you can choose from. In this way the plans are similar to HMOs. It is always more cost effect to use an in-network provider when seeking medical treatment. Providers who participate with your insurance company have an agreement to accept lower payments and in return, receive access to patients who participate with the insurance company’s network. One advantage to a PPO is that beneficiaries do receive coverage for some out-of-network care. If you decide to use an out-of-network provider you will most likely have to pay a higher rate for your care but the insurance carrier will pay some of the cost.
Another benefit of joining a PPO is that you will not be required to get a referral to see a specialist. You can choose from any in-network provider for medical services
PPO plans might be a good fit for you if:
- You do not want to get a referral before seeing a specialist.
- Sometimes you want to use an out-of-network provider.
- It is important for you to have the choice of where you receive your medical care.
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