Preferred Provider Organization
PPO or Preferred Provider Organization is another type of managed care plan. It is a combination of an HMO and fee-for-service plans.
Access to health care providers: Like an HMO, PPO has an approved network of providers (also called “referred” providers). When you use these providers, most of your medical bills will be covered.PPO allows you to see other providers outside the network and still receive coverage. But this will cost you more. Like FFS, PPO will charge you higher coinsurance rate (and also fill out claim forms) when you go outside the network.Health Care Services: Just like HMOs, PPOs cover a comprehensive range of services, including preventive care, i.e.,visits to the doctor, well-baby care, immunizations, and mammograms.For further treatment, you may seek specialists within the network without the need of a referral from your primary physician or you may choose to go outside the network.Cost/Cost Management: On top of monthly premiums, PPO requires you to pay a small co-payment for doctor’s visit and hospital treatment.For some services, you may pay a deductible, and there is also a set coinsurance amount (which is higher when you use out-of-network providers).With PPO, you simply present your member card when you visit a doctor’s office or go to a hospital and you don’t have to fill out forms. You only fill out claim forms when you use a provider that is not part of the network.Advantages: You have the choice of seeing any doctor or specialist you wish either within the network (at a lower cost) or outside.Disadvantages: Co-payments are larger than other managed care plans, and you may need to satisfy a deductible. In addition, you pay more and fill out claim forms when you choose an out-of-network provider.PPO may be a good option for you if you want to have the freedom to choose your provider within the network without a ‘gatekeeper’ or a referral, at the same time seek further treatment outside the network when necessary.
Let’s now find out what POS plan is all about.
Proceed to Step 4: Know Where to Get Health Insurance Coverage