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PPO Health Insurance Comparison

By Marilyn Katz

Republish: EasyPublish™
Published: 22Oct2009
Word count: 509
Viewed: 247 time(s)

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What is PPO Health Insurance?

The acronym, PPO, stands for Preferred Provider Organization. This means that part of the health insurance plan is a nework of medical services providers. This network will contract to provide services at agreed rates in exchange for being listed in the plan's directory.

How Do PPO Plans Benefit Doctors and Insurers?

This should benefit the organization and the medical provider. The insurer can offer a large selection of doctors, hospitals, etc. to customers. The medical offices, in exchange, may get a steady stream of clients. Many insured people will consult the PPO directory, either printed or online, in order to find a doctor or other medical professional.

How Does PPO Health Insurance Benefit Insured People?

And this should also benefit the health insurance plan's insured people. They will be covered at a better rate if they choose to take medical treatment from the PPO members providers. For example, a PPO plan may cover 80% of treatment costs, after a deductible from a PPO member. They may only cover 50% of the costs if a member decides to seek treatment outside the network.

So out of pocket costs should be less when services come from a network provider. The insurer uses its membership to control costs for itself, and also for its clients.

Does this mean that out of pocket costs are eliminated? No, we have seen providers charging more than insurers will pay, and there will usually be deductibles, copays, and even yearly maximums. It is important to do some research before choosing a provider and service, if that is possible.

Are There Exceptions?

There are usually network coverage exceptions. Emergency treatment will usually be covered at the in-network rate, even if a patient must seek care outside the network. Again, please take the time to understand a policy before you need to use it in a hurry.

There may be some other exceptions in case a network does not have a specific provider. A patient should get this pre-authorized in any non-emergency situation.

These plans are very popular. They do help control costs. And they also allow some flexibility. In some situations, a patient may choose to seek medical treatment from a doctor or hospital outside the network. They will understand that they will not be covered at the same rate, but they can still be covered.

Why would anybody leave the network? Perhaps a covered person develops a specific condition, and they learn an expert on that condition is in their city, but is not part of the network. They may choose to be covered at a lower amount in order to consult with that expert.

They can always take the information they get from the consultation back to their regular, network doctor. Or that expert may just confirm what the network doctor said, and this will give the patient peace of mind.

Compared to alternatives, many feel that preferred provider organiations can control patient costs while allowing choice. That is why these health insurance plans are very popular with consumers who seek insurance.

We want to help you compare individual health insurance plans, including PPO, HMO, and HSA major medical. Find PPO health insurance quotes.

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