PPO Health Insurance
PPO health insurance is known to be a fairly expensive health care option, although it can provide a great deal of flexibility. PPO actually stands for preferred provider organization, but it is often referred to as participating provider organization or preferred provider option. If a consumer has a PPO this will typically mean that their insurance company will have a network of health care providers available to them at their discretion.
The health care provider will typically file a claim with a consumer’s insurance company or PPO carrier, and the customer will then need to pay the difference between the bill and the insurance payment. If an individual selects PPO coverage, they can see any doctor, specialist or health care office that forms part of the provider network that is offered by the PPO carrier.
Therefore, there is no requirement for an individual to register a standard, personal physician with their insurer. A policyholder also has the choice of visiting a doctor out of their network, although their insurance will not cover this visit. It is actually fairly easy to find out which doctors are in the PPO network, and an individual can merely ask their doctor’s office personally.
The vast majority of insurance companies that offer PPO health insurance will also provide a website filled with relevant tips and information. This will additionally help consumers to find in-network doctors in their specific area. A person may find that their current doctor forms part of the offered network, although they should also be prepared if they are not.
What exactly is covered with PPO health insurance?
PPO insurance will always cover basic office visits, but consumers may need to make co-pays, which are standard fees that need to be made to a physician in order to be seen by him or her. There is also coverage for preventative care, such as routine exams and annual physicals. PPO health insurance will cover hospital and emergency care, prescription drugs, outpatient surgery, and specialist care.
There is typically a 60%-70% reimbursement for emergency room visits, but if an individual is admitted to hospital the level of reimbursement may change. As mentioned, PPO health insurance will pay for a person to see a specialist, and the specialist must be chosen from the network. However, in order to see a specialist, a person will require a referral from their primary care physician.
Where can consumers get PPO health insurance from?
Most insurance companies will offer PPO health insurance. Many individuals also find that they have insurance through their employer, and they have the option to elect the PPO option when they first sign their employment contract. Employees also have the option to change their selections during the open enrollment period. The open enrollment period is a specific timeframe that allows an individual to change most of their health care options, but these options cannot be changed as easily outside of this time period.
For consumers wishing to obtain PPO health insurance from an insurance company, as opposed to their employer, they will find various insurance company, insurance brokerage, and price comparison websites online. These websites will typically provide a great deal of information, and will have insurance agents on hand to discuss a potential applicant’s details and personal situation further.
Health maintenance Organization (HMO) is a similar type of plan to PPO, but it is considered to be far less flexible. Most people are initially unsure about which form of coverage they should opt for. The main difference with an HMO is that the organization will always refer a customer to a specific physician or specialist for their care.
Therefore, when an individual visits a medical professional, that person will first need to be approved by the HMO. Once the physician has been approved, the client can continue to see that physician. This will mean that individuals must register their primary care physician or doctor, and the insurance company must be notified of any changes. HMO’s are generally less expensive than a PPO, but they don’t offer the flexibility that a PPO does.
When choosing PPO health insurance, a customer has a number of things they need to consider. Firstly, they will want to ensure that there are participating providers within their local area, and that their preferred hospitals also form part of the covered network. This is because using physicians or hospitals outside of the network is likely to result in far higher premiums and co-pays. It is also important to review the limitations and exclusions, so a policyholder is completely aware of what is and what is not covered by their plan.