A PPO plan allows you to visit a hospital or doctor in the network. However, this plan is typically more expensive than an HMO. Your out-of–pocket expenses will also be higher. Whether a PPO is right for you depends on your needs and your budget. A PPO has many benefits.
Flexibility is one of the greatest benefits of a PPO plan. Providers can be found in nearly every state and city. This allows you to easily locate the best doctors and medical care in your locality. You may also find that the PPO network makes it easier to pay for services in your area.
A PPO offers another benefit: the freedom to choose your preferred primary care doctor. You may not require a referral from a PCP in certain cases to see a specialist. You will need to refer a specialist if you don't have a PCP referral. However, you will pay more if you see a specialist with a referral. It is also important to note that you may have to pay a copay, or a fixed dollar amount, for certain healthcare services.
Calling your insurance company before you seek out care from outside-of network providers may help to reduce this cost. Calling the insurance company before you receive care from an out-of-network provider can help to prevent your claim being denied. It also helps to avoid unnecessary costs.
A PPO allows you to use any provider within the network. This gives you the freedom to choose the doctor you want. You will still be responsible for all care received outside the network. Although insurance companies and physicians often agree to lower the usual rates for their services, you could still end up paying more if they choose to refer you to an out of network provider.
Another advantage of a PPO is the fact that your doctor and other medical professionals can negotiate schedules and fees with the health facilities they work with. A PPO gives you greater options for testing and laboratory locations. You can receive the care you need even when you are away or traveling.
When choosing a PPO, you must also consider copays, deductibles, and coinsurance. The deductible is a set amount that you must pay each year before your insurance coverage kicks in. The coverage typically covers the first $1,000 of your expenses. Your insurance company will pay the remainder. You pay a fixed amount of money each time you visit a provider. You may have to pay for tonsillectomies or birth control depending on which plan you have. Likewise, you can pay for medications you take at the pharmacy, but you will have to check with your insurance company about what types of prescriptions are covered.
PPO insurance policies are a good option for people who manage their own healthcare. People who frequently travel and want to have the option of seeing any healthcare provider can opt for this type of insurance. The best health insurance plan for you is dependent on your personal needs, your budget and your lifestyle.