Preferred Provider Organizations (PPO'S)
A Preferred Provider Organizations is the least
restrictive type of managed care. PPOs have made arrangements for
lower fees with a network of health care providers. PPOs give their
policyholders a financial incentive to stay within that network.
For example, a visit to an in-network doctor might
mean you'd have a $10 co-pay. If you wanted see an out-of-network
doctor, you'd have to pay the entire bill up front and then submit
the bill to your insurance company for an 80 percent reimbursement.
In addition, you might have to pay a deductible if you choose to go
outside the network, or pay the difference between what the
in-network and out-of-network doctors charge.
With a PPO, you can refer yourself to a specialist
without getting approval and, as long as it's an in-network provider,
enjoy the same co-pay. Staying within the network means less money
coming out of your pocket and less paperwork. Preventive care
services may not be covered under a PPO.
Exclusive Provider Organizations are PPOs that look
like HMOs. EPOs raise the financial stakes for staying in the
network. If you choose a provider outside the network, you're
responsible for the entire cost of the visit.
Is a PPO Wright For You?
Rates and coverage vary form state to state so shop around on your
own or talk to an independent insurance agent to make sure you get a
plan that's right for you. For more information and rates on PPO
health insurance visit our specialist site below.