PPO
Preferred Provider Organization

PPO or Preferred Provider Organization is another type of managed care plan. It is a combination of an HMO and fee-for-service plans.

PPO allows you to see other providers outside the network and still receive coverage. But this will cost you more. Like FFS, PPO will charge you higher coinsurance rate (and also fill out claim forms) when you go outside the network.

Health Care Services: Just like HMOs, PPOs cover a comprehensive range of services, including preventive care, i.e.,visits to the doctor, well-baby care, immunizations, and mammograms.

For further treatment, you may seek specialists within the network without the need of a referral from your primary physician or you may choose to go outside the network.

Cost/Cost Management: On top of monthly premiums, PPO requires you to pay a small co-payment for doctor's visit and hospital treatment.

For some services, you may pay a deductible, and there is also a set coinsurance amount (which is higher when you use out-of-network providers).

With PPO, you simply present your member card when you visit a doctor's office or go to a hospital and you don't have to fill out forms. You only fill out claim forms when you use a provider that is not part of the network.

Advantages: You have the choice of seeing any doctor or specialist you wish either within the network (at a lower cost) or outside.

Disadvantages: Co-payments are larger than other managed care plans, and you may need to satisfy a deductible. In addition, you pay more and fill out claim forms when you choose an out-of-network provider.

Step 1: Know the Health Insurance Terms.

Step 2: Assess Your Health Insurance Plan Needs.

Step 3: Which Health Insurance Type is Right for You?

Step 4: Where to get Health Insurance Coverage.

Step 5: Get the Best Health Insurance Quote Available.

Step 6: Make the Right Health Insurance Choice.

Step 7: Submit your health insurance application.

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