Preferred Provider Organization Plans — PPO Plans, Coverage, & Quotes
PPO insurance is a type of family health insurance. A Preferred Provider Organization plan (PPO health plan) works under a managed care system, which means that you can choose from a group of providers, e.g. hospitals and physicians. PPO plans allow you greater freedom than HMOs within your family health insurance plan. You pay monthly premiums, as well as a deductible and co-payments to receive comprehensive health care services.
A PPO health insurance plan lets you select any doctor of your choice, although choosing one within the PPO network serves to maximize the value of affordable family health insurance. If you choose a doctor within the network of your PPO medical plan, the only out-of-pocket cost is a nominal co-payment. PPO plans will pay a portion of the cost to see an out-of-network physician, although those visits will be more expensive for you. There will be no paperwork involved in settling claims have to fill out and submit paperwork in order to get the partial claims paid for if you go out-of-network. PPO health plans also allow you to use “self-referral”; this means that you can schedule a visit with an in-network specialist on your own, instead of waiting for your primary care physician to refer you. This can save you time and money by decreasing the number of doctor visits you must make. Going outside of the preferred network is possible, but far more costly. It is recommended that you compare PPO family health insurance plans and see if your family’s doctors are in their networks; the networks of some PPO insurance plans are larger than those of other PPOs.
Although it’s a good idea to specify a primary care physician for your family, with PPO health insurance plans you are not required to choose one. A PPO health plan doesn’t force you to have a gatekeeper in charge of your family’s health care, which has an appeal. On the other hand, PPO plan premiums are normally higher. You will also have to pay more in co-insurance and co-payments. A high-deductible PPO may lead to lower monthly premiums, but deductibles depend on several factors. You must also be careful of PPO plans is many only cover the specified percentage of “reasonable costs” for out-of-network medical treatment. Very expensive hospitals or physicians can result on you being on the hook for unexpectedly large bills exceeding your typical co-insurance.
Is a PPO health plan right for you and your family? VitalOne’s licensed insurance agents are here to help guide you through the process of comparing the cost and coverage available with multiple PPO plans.