5 Facts about PPO Insurance

PPO insurance stands for preferred provider organization. Regardless of the actual insurance company you are contracted with, there will typically be a PPO option. With PPO insurance, you will have to visit medical professionals associated with your organization in order to get your insurance benefits. 

#1 PPO Insurance Is Flexible

The first thing to understand about a PPO plan is the flexibility it offers. While you will have to visit an in-network doctor, you will have your choice from there. Most networks are extensive, providing you with hundreds of options for care providers. You do not need to notify your insurer before going to one of these care providers. Instead, you send in the claim after your visit. The main exception is in seeing a specialist. When you see a specialist, most insurers will require a referral to show you could not receive the care your required through a primary care physician.

#2 PPO Insurance Is Expensive

Because PPO insurance is so flexible, it is typically more expensive than other options. You will not typically get better coverage in response for the higher cost; this means you will still owe about the same on any claim as with other options. You are truly paying for the flexibility. 

#3 PPO Insurance Covers a Portion of Your Expense

For each claim, your PPO insurance will cover a portion of the cost. This portion depends on the plan you elect. For example, your insurance may cover 60% of an emergency room visit or 70% if you are admitted to the hospital following the visit. You can check how much is covered in your benefits packet. This is typically mailed to you a few times throughout the year. Your insurer may also have a website that discusses your benefits in clear format.

#4 PPO Insurance Is Different than HMO Insurance

HMO insurance is a plan similar to PPO insurance, but there are a few key differences. HMO insurance is less flexible. With an HMO, or health management organization, you will have to declare a primary care physician before visiting that medical professional. You will always need to register the doctor you are visiting first with the insurer before making an office visit. This can be cumbersome, but this allows the insurer to better manage the cost incurred on each visit. You will typically save money with an HMO because the insurer has less expense and passes these savings on to you.

#5 PPO Insurance Is Only One Option

PPO insurance is only one of many options for medical coverage. As mentioned above, HMO insurance is another option. There are also a number of risk pools and consumer driven options that are becoming more popular in recent years. Ultimately, it is important to understand the decisions you make for your insurance plan and health care will directly affect the expense you incur. If you are smart about using physicians, for example relying on nurse hotlines or emergency clinics instead of hospitals when possible, you will spend less each year on your medical care.

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