A PPO is a type o insurance that lets you see a doctor, hospital in network, and out of network. The plan is more expensive than an HMO and you will have higher out-of-pocket expenses. Your needs and budget will determine if a PPO is right. There are many benefits to choosing a PPO.
Flexibility is one of the greatest benefits of a PPO plan. PPO networks can be very large, and providers can be found in almost any city or state. This allows you to find the best medical care and doctors in your region. The PPO network encourages in-network healthcare so you might pay less for the services that you require.
A PPO offers another benefit: the freedom to choose your preferred primary care doctor. Sometimes, you won't need to have a referral from your doctor in order to see a specialist. However, if you do require a referral from your PCP, you will be charged a higher fee if you go to a specialist without one. You may also need to pay a copay (or a fixed amount) for certain healthcare services.
Calling your insurance company before you seek out care from outside-of network providers may help to reduce this cost. Calling the insurance company before you receive care from an out-of-network provider can help to prevent your claim being denied. It also helps to avoid unnecessary costs.
When you have a PPO, you are free to use any provider in the network, so you have the flexibility to choose the physician you prefer. However, you will still need to pay for care that you receive outside the network. Even though insurance companies and doctors often offer lower rates, it is possible to pay more if you use an outside-of-network provider.
A PPO offers another benefit: Your doctor and any other medical professionals can negotiate with health facilities about fees and schedules. A PPO gives you greater options for testing and laboratory locations. This means you can get the care that you need, regardless of whether you are at home or abroad.
Copays, coinsurance, and deductibles are all important factors to consider when selecting a plan. You will have to pay a fixed amount each year before your health coverage kicks in. The first $1,000 of your costs is usually covered. Your insurance company will usually cover the remainder. The copay is a fixed dollar amount you pay for each visit to a provider. You may have to pay for tonsillectomies or birth control depending on which plan you have. You can also pay for medication you purchase at the pharmacy. Your insurance company will be able to tell you what types of prescriptions they cover.
A PPO health insurance policy is an excellent choice for those who are self-managing their own medical care. People who frequently travel and want to have the option of seeing any healthcare provider can opt for this type of insurance. The best health insurance plan for you is dependent on your personal needs, your budget and your lifestyle.