PPO Insurance Basics
- Health insurance helps people to pay for medical emergencies.The doctor and the patient image by Vladimir Usatschenko from Fotolia.com
Preferred Provider Organizations (PPO) are health insurance plans that manage a network of medical providers in an effort to control the costs for both the company and patients. Patients are provided with incentives to seek care within the network of medical providers and hospitals. If a patient uses a medical provider outside of the network, out-of-pocket expenses will be greater than if the patient uses a doctor or facility within the network. - Unlike an HMO plan, participants in a PPO health plan are not required to go through their primary care physician to see another doctor or specialist. Members of a PPO can schedule an appointment with any provider who is a member of the network at any time. In other words, your primary care physician is not a "gatekeeper" controlling the level of care you choose. This is a very important fact for you to remember when you select the PPO network you want to participate in. If you select a PPO network that has a limited number of specialists, you will end up with significantly greater out-of-pocket costs if you are forced to seek care outside of the network.
- Monthly payments for your insurance coverage usually are made through a group plan at your place of employment, or through a professional organization. At the time you visit a doctor, your PPO typically expects that each patient be responsible for a $10 to $20 co-payment. If you visit an out-of-network provider, you may have to pay the entire bill yourself and then submit the bill for reimbursement. The level of annual deductible you choose for your insurance policy will directly influence your monthly payment. The larger the deductible you select, the lower you monthly payment.
- If you become seriously ill, or are involved in a major accident, managing your medical care can be a very overwhelming responsibility. Membership in a PPO provides you or someone close to you with the opportunity to have control over the course of your care, and yet have the resources available within your network to receive help. You have the freedom to select a primary care doctor of your choice, or to forgo a primary care physician and work directly with specialists. Managing your health care also involves consideration of the financial responsibility of co-insurance costs. PPOs typically require a co-insurance share be paid before the insurance company pays the bulk of the bill. A co-insurance split may be 20/80 or 30/70, with the patient paying the initial 20 or 30 percent of a large medical bill.
