What is PPO Health Insurance?

PPO health insurance is a flexible and expensive health care option. It stands for preferred provider option network. The PPO means your insurance company will have a network of care providers available to you at your discretion. The care provider will file the claim with your PPO carrier, and you pay the difference between the bill and the insurance payment.

Who You Can Visit with PPO Health Insurance

You can see any doctor or specialist within your provider network when you elect PPO coverage. You do not have to choose a standard, personal physician and register that physician with your insurer. If you choose to see a doctor out of your network, the insurance will not cover the visit. You can find out which doctors are in your network by asking the doctor's office personally. Most insurance companies also have websites that assist you in choosing in-network doctors in your area.

What is Covered with PPO Health Insurance

Basic office visits are covered under your PPO insurance. You may have a co-pay, which is a standard fee you have to give the physician in order to see him or her. Depending on your insurance plan, other activities will also be covered. Typically, there is a 60-70% reimbursement for an emergency room visit. If you are admitted to the hospital, the reimbursement may change. PPO coverage will typically pay for you to see a specialist, and you will get to choose a specialist from the network. First, though, you will need a referral from your primary care physician.

Where to Get PPO Health Insurance

Most insurance companies offer a PPO option as one of their many choices. If you have insurance through your employer, you can typically elect the PPO option when you first sign your employment contract. You can change your elections during the open enrollment period. This is the timeframe when you can change most of your healthcare options, but you will not be able to change them easily if you are outside of this time period. Individuals that are not insured with their employer will have a harder time locating a flexible PPO option that is also affordable. They may have to go with a less-flexible insurance election in order to get coverage.

How PPO Health Insurance Differs from an HMO

HMO stands for health maintenance organization. These groups are similar to PPOs in many ways, but they are less flexible. The biggest difference with an HMO is this organization will always refer you to a specific physician or specialist for your care. When you make a visit a medical professional, that person will have to first be approved by your HMO. Once a physician is approved, you will be able to continue seeing the physician. This means you will have to register your primary care doctor, and you will have to notify your insurance company if you change. Though the option is less flexible, it is usually cheaper than a PPO.

blog comments powered by Disqus