A PPO insurance policy gives you more choices than your standard health insurance does. You do not have to get a referral from your primary care doctor to see some specialists, and you are able to go to other providers not covered by the insurance company. However, something to remember: if you get treatment from an outside provider, then your out-of pocket expenses can be much higher. Read on for more information about choosing PPO insurance and what options are available.
The way a PPO plan works is that you pay a specific co-payment for doctor visits and treatments. The co-pay can vary widely, depending on the health problem and location of the visit. Some plans have a fixed annual co-pay or a fee-for-service payment. If you visit the same doctors often, you may pay slightly less in a fee-for-service policy. Some PPO plans have no co-payment requirement.
The types of doctors and specialists covered by a PPO plan will depend on your coverage. There is flexibility with deductibles, too. A higher deductible usually means a lower monthly premium. Deductibles and monthly premiums can be adjusted with each individual provider.
Another option for additional choices is network exclusions. Networks can sometimes exclude certain medical providers. In general, however, networks should accept all patients, regardless of health issues. If your primary care physician (PCP) recommends a particular doctor, then that doctor will be listed with that provider in the network. If you have a referral from your primary care physician, you will likely have more freedom in choosing primary care physicians and specialists.
Networks may also allow referrals to go to any primary care physicians or specialists that accept Medicare. In some networks, you can choose among different specialists at different times, even if they accept Medicare. However, if you change your doctor after you’ve made your initial doctor’s appointment, you may have to change your primary care physician. Your PCP will provide you with a list of specialists to select from, but you may not be able to switch back after that.
Most providers offer “PPO” plans, also called Preferred Provider Organizations. A PPO allows you to select a physician and a specific hospital, regardless of where you go for care. If you’re in great health and travel frequently, this can be very beneficial because it can save you a lot of money on hospital bills. For instance, a single surgery could cost up to thousands of dollars, but if you’ve signed up for a PPO instead, you only have to pay for one surgery. Keep in mind that this type of health insurance plan is not available for every health insurance plan.
There are other plans available that let you select between hospitals, doctors and specialists. Your health insurance plan member has the freedom to choose which doctors and which hospitals he wants to treat him. A few of the plans allow plan members to select “any” doctors and hospitals they want, but most require a referral from the primary care physician. This means that if your primary doctor doesn’t accept Medicare, you’ll likely have to find a specialist. Some of the providers offer “dummy” plan members free primary care visits if they agree to a specific amount of time they’ll have to seek out a specific doctor. You can find out more about what each PPO provider offers by calling the toll-free number or by visiting the website.
When you compare the costs and services of various PPO plans, keep in mind the differences between HMOs and PPOs, as well as the differences between providers. HMOs usually provide better overall patient care, but their lower premiums mean that some people with private insurance don’t choose them. On the other hand, PPO plans are designed to give you lower premiums while giving you better coverage for your health care needs.