subject: Ppos And Health Insurance [print this page] A PPO, or Preferred Provider Organization, is just one of the many different types of health insurance coverage available on the market today. Usually offered by employers that are big enough to provide large group insurance, this is one of the more common and desirable types of health insurance today.
With more than half of all consumers enrolled in a private health insurance plan utilizing a PPO, this is the most popular type of policy currently offered in the United States. There is no requirement to obtain a primary care physician, and enrollees have the option of utilizing both in-network and out-of-network services. Patients do not have to obtain prior authorization to see specialists or other doctors as with HMOs, but may need to consult their insurance company for more expensive services such as surgeries and hospitalization.
Premium costs depend on a couple of factors. Group PPO plans are required by law to charge the same premium amount across individuals that are considered to be in the same group (such as part-time vs. full-time) despite any pre-existing conditions or significant medical history. However, often employees have the option of choosing between two or three different PPO plans, with more extensive coverage often requiring a higher premium. Rates also vary across companies and even geographic areas. In addition, small group coverage premiums will be higher since there are fewer people to offset medical expenses.
PPOs offer in-network services to their customers for reasonable prices. Providers that are considered to be in-network have previously agreed to set amounts to be reimbursed for different procedures and office visits. Some PPOs are locally based, limiting employees to care at certain local hospitals and physician offices, while others offer in-network care options nationwide. Out-of-network services are always an option, with some level of coverage offered, though usually significantly less than in-network options.
In contrast to HMOs, PPOs offer the patient the choice of care, allowing him or her to choose the best option for their specific needs and preferences. This type of health plan is generally considered to be the one that offers the best possible patient care, not only allowing for consumers to choose their providers, but also allowing for physicians to refer their patients to the most qualified specialists available.
While there are a number of apparent benefits of this type of health insurance plan, there are some negative aspects, as with anything else in life. Co-pays and deductibles are generally higher for individuals enrolled in PPOs than those that are involved in an HMO. In addition, since this type of provider does not have nearly the control as an HMO provider, significantly more paperwork is required in the claims process, which can not only make the process longer, but also increase the potential for mistakes, whether it is human or computer error.
Compare your options when it comes to considering a PPO, and you can rest assured that you made the best decision for you and your family.
by: Casey Trillbar
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