PPO - Preferred Provider Organization
What is a
PPO?
A PPO
(Preferred Provider Organization) is a network of doctors, hospitals
and other health care providers that have been contracted by an
insurance company or health plan to provide care at a discount.
PPO plans have two benefit schedules--one for In-Network and another
for Out-of Network services.
How
does a PPO Plan work?
PPO subscribers
are given a PPO directory, which lists participating health care
providers.
Any provider on the list may be used to take advantage of the PPO
benefit schedule and discounted fees.
Referrals are not required to visit a specialist.
Reduced benefits, similar to traditional Indemnity insurance, are
paid for utilization of Out-of-Network Health care providers.
What
are the advantages of a PPO Plan?
Because
of negotiated discounts, out-of-pocket expense can be kept reasonable
by using PPO providers.
There are no deductibles for some PPO benefits.
Flexibility in choosing health care providers because benefits are
paid for both In-Network and Out-of-Network services.
There is freedom of choice among In-Network providers, including
specialists. When In-Network providers are used, out-of-pocket expenses
are lower and no claim forms are required.
Are there
any drawbacks to a PPO Plan?
The value of
a PPO plan depends on the availability of providers, by the area
in the network. Claim forms are required for Out-of-Network benefits.
Questions to
ask about this health plan.
Are
there many doctors to choose from?
Who are the doctors in the PPO network?
Where are they located?
Which ones are accepting new patients?
How are referrals to specialists handled?
What hospitals are available through the PPO?
Where is the nearest hospital in the PPO network?
What arrangements does the PPO have for handling emergency care?
What services are covered? What preventive services are offered?
Are there limits on medical tests, out-of-hospital care, mental
health care, prescription drugs, or other services that are important
to you?
What will the PPO plan cost?
How much is the premium?
Is there a per-visit cost for seeing PPO doctors or other types
of copayments for services?
What is the difference in cost between using doctors in the PPO
network and those outside it?
What is the deductible and coinsurance rate for care outside of
the PPO?
Is there a limit to the maximum you would pay out of pocket?
|
