PPO Insurance

PPO is an abbreviated version of the word Preferred Provider Organization. In a PPO insurance plan the health insurance plan is based on a relationship between the insurance companies and the organizations. The relationship between these two is purely a contractual relationship. Here we should note that the health care providers, the clinics, the hospitals, doctors etc., themselves are the organizations. Plans in PPO have lists of the healthcare providers that are pre-approved in advance. These pre-approved lists are called the Participating (In-Network) Provider lists. Non-Participating (Out-of-Network) providers are those health care providers who are not in the list of the PPO insurance plans. But they allow you to see the health care providers who are not in the pre-approved lists.

The plan of action:

It should be noted that when you use a non participating provider you may end up paying more amount than what you would have to pay if you had used one in the network. One benefit which they provide is that they allow you to see those healthcare providers who are not on the list which is called the Non-Participating (Out-of Network) Provider list. You will have to end up paying more when you choose a non-participating provider. This does not happen when you choose a provider that is in the network.

Advantages of a PPO insurance plan:

• Access: One of the biggest advantages of having a PPO insurance plan is that you have access to a large number of facilities and doctors.

• Choice: For your healthcare needs you can choose whatever doctor you want to see. Nobody is going to force you and you are the ultimate person to decide for yourself which insurance plan you wish to have.

• Specialists: As far as seeing a specialist is concerned, you don’t need to have a referral to see a specialist.

• Primary Care Physician: After selecting the primary care physician, you do not have to be tied up for taking the services of the same physician.

• Negotiated Fees: When you decide to choose a participating provider the amount that you will have to pay, is a negotiated amount which is comparatively less than a health provider who would charge someone without a plan.

Disadvantages of a PPO insurance plan:

Deductible: The PPO insurance plans always have certain deductibles that have to be met.

Co-Insurance: There also exists a co-insurance amount that you have to pay. After the deductible is met there is an average amount which is approximately 30 percent of the cost that has to be paid.

Out of Pocket expenses: Between the deductibles to be met and the co-insurance, in overall the PPO insurance plans can cost you much more as they include other out-of-pocket expenses.

Whether you are willing to pay extra for open access to the healthcare provider, or not is entirely your choice. Whether you want a HMO, PPO, or a HSA, it is a better option to consult a local health insurance agent or a broker. By consulting them you would be able to find the right plan for yourself.

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