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PPO Insurance – Good for You?

There are a lot of decisions to make when it comes to choosing a health insurance plan. One of the first decisions you will need to make is which type of plan is right for you.

You’ve probably heard the terms health maintenance organization (HMO) and preferred provider organization (PPO), but do you really understand the differences between the two? In this article, we are reviewing the benefits of a PPO.

PPO plans provide more flexibility when picking a doctor or hospital. They also feature a network of providers, but there are fewer restrictions on seeing non-network providers. In addition, your PPO insurance will pay if you see a non-network provider, although it may be at a lower rate.

One of the major reasons people like PPO insurance programs is the lack of referral requirements. You do not need to get a referral from your primary physician to see a medical specialist. This can save you an extra office visit and co-pay. You may also be able to get in to see a specialist more quickly when you have an urgent care need. For people who need to see specialists for a variety of reasons, this plan benefit is significant.

Another benefit is that you don’t have to commit to a single primary care physician. This is especially convenient if you travel frequently and can’t consistently see the same doctor every time, you’re due for an appointment. And you can see the doctor or specialist you’d like without having to see a PCP first.

You can see a doctor or go to a hospital outside the network, and you may be covered. However, your benefits will be better if you stay in the PPO network.

A PPO plan is designed to give you more flexibility in choosing which health care providers you see. Care is typically more affordable if you stay in-network. But if you have a doctor you prefer to see, it might be easier to visit him or her with a PPO plan.

Another advantage of a typical PPO structure is that you do not have to file claims. Because the insurer and providers have a contractual arrangement, they collaborate on the payment process. You receive service and typically pay your portion on the day of service. The provider submits the service claim directly to the insurance company. Barring any issues, the claim is approved and paid without your participation. You receive an explanation of benefits showing the results. Providers are usually hooked into insurance companies through a computer network. This allows them to quickly process your insurance and let you know what you owe on the day of service.

Out-of-network availability

While it’s recommended that you seek care from a doctor or hospital that’s within your network, you can still get the care you need partially covered if you go outside of your network. You’ll just have to pay more additional out-of-pocket costs than you would if you had gotten care from one of the preferred providers.

For more information, contact Bethany at 936-220-2133 or complete our contact form.

health plan basics ppo

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