Other than an HMO, a PPO may be a good choice for you. PPO plans are based on relationships insurance companies have with various organizations that provide health care; meaning clinics, doctors, hospital and other health care providers,” said Clelland Green, RHU president of Benepath, Pennsylvania.
Due to the fact that they have this “list,” the PPOs are able to provide customers with a pre-approved list of health care providers that are members of the PPO “network,” which is actually called the participating in-network provider list. “Happily however, this does not mean you are restricted to just seeing those on the list. Just make sure that you are aware that if you do use a non-participating provider, you’ll be paying more than if you had stayed in-network. Sometimes however, it’s worth spending the money,” Green added.
You may also opt to see other health care providers on another list of sorts called the non-participating out-of-network provider list. There is nothing like have options when it comes to being able to choose the heath care plan that is right for you. And, if you don’t know exactly what you’re looking at or have questions, this is the time to talk to an experienced licensed insurance broker who will have the answers and information you need to know.
“So what good reasons do we have to choose a PPO? Well, good access to a larger number of doctors and other medical facilities; the choice of who you want to see for medical care; you don’t need to be referred to a specialist; you don’t have to pick a primary care doctor; and the negotiated fees will be less. For example, when a person does use a participating provider, the charge is a negotiated sum that is less than the provider would charge someone who does not have the plan,” Green outlined.
On the con side of the sheet, there are deductibles to be met; co-insurance after the deductible is met of up to about 30% and a lot of out-of-pocket expenses. For instance, with PPO Plans the cost to you is higher between the deductible and co-insurance and other out-of-pocket expenses.
“OK, so the final question is this: Are you willing to pay out extra to be able to access any doctor or other health care provider that you choose?” asked Clelland Green, RHU president of Benepath, Pennsylvania.
