A preferred provider organization (PPO) is an insurance program that allows options in choosing co-pays, deductibles, and providers.
In a PPO plan, the insured selects a primary care physician from a list of doctors that have agreed to perform medical care at lowered prices. These doctors are preferred or “in network.” The primary doctor may suggest a specialist, but the patient does not need a referral before he can see that specialist. Insured clients who want services from providers not on the list are expected to pay a greater portion of the fee for that “out-of-network” service.
Request more information about Ohio PPOs NOW
Advantages of a Preferred Provider Organization
- Out-of-pocket charges are tied to the selection of deductible, the amount of the co-pay, and the percentage of co-insurance on the plan.
- Preventive care is usually covered and emphasized.
- Using the “in-network” or preferred provider list is a good way to lower fees.
- After the deductible is met, the plan pays an pre-agreed portion of fees.
- A small co-pay is required at each visit, and is the portion of the charge remaining after the PPO pays its share.
Disadvantages of a Preferred Provider Organization
- Out-of-pocket charges are larger than for an HMO.
- Except for some preventive care, the plan only begins to pay for services after your deductible is met.
- If out-of-network services are used, claims may need to be filed by the patient.
- Pre-certification is required for all hospitalizations and most elective treatments.
Request more information about Ohio PPOs NOW
Preferred Provider Organization (PPO) Plan Details
The goal of this sort of insurance is to reduce rates through using a network or a select group of providers that have agreed to give deep rate discounts to the insured. The patient is encouraged to use providers within the list. The PPO keeps track of the number of visits and the care received to ensure that an ideal number of visits takes place. The PPO governing board also determines which treatments may be covered under the plan.
This type of plan has the greatest flexibility overall. Selecting a high deductible lowers the monthly premium costs for those who infrequently visit the doctor. Selecting a lower deductible demands a higher premium but lower initial costs for those who need care more often. The plan usually pays a percentage of charges after the deductible is met (for instance, 80 percent of all costs), while the patient pays the remaining amount.
