PPO Health
Insurance Plan - What Is It?
August 6th 2006
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PPO Insurance |
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A Preferred Provider Organization, or a PPO, is health care organized by
a particular insurance company. Medical professionals, hospitals, and
clinics are contracted by the insurance company to work with the PPO
system. The PPO decides the managed medical care guidelines and the fee
schedule and the medical professionals, hospitals, and clinics that are
contracted by the PPO agree to these terms.
A PPO is similar to a health maintenance organization (HMO) in that it
offers a network of health care professionals available to the insured
person; however, a PPO is more flexible than an HMO in that a PPO also
offers the option of seeing an out-of-network health care professional.
Many times people would rather visit their family doctor, or a doctor
that is highly recommended, than a doctor in the PPO network with whom
they may not be familiar. Yet, PPO networks usually represent a high
number of medical professionals, doctors, and clinics over a large
geographic area, so finding an agreeable doctor might not be that
difficult.
The insurance offered by a PPO usually covers a high percentage of the
cost to see a health care professional in the PPO network, and the
insured person will pay a co-payment at the time of the doctor,
hospital, or clinic visit. Fees for out-of-network health care
professionals are often higher than fees for seeing a health care
professional in the PPO network. PPOs want to encourage the insured
person to visit a doctor within the network, but it is obviously not
required. PPOs also require the insured person to pay a yearly
out-of-pocket fee before medical bills will be covered.
Other advantages to a PPO are the fact that its premium is less
expensive than that of an individual health insurance plan and the fact
that PPO networks usually have a plan that will offer prescription drugs
at much lower costs. A PPO will also cover more medical services than an
individual health insurance plan.
Jessica Farrell
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