A Primer on PPO Insurance Plans

Wednesday, October 21st, 2009 at 2:40 pm

Most, if not all Americans have some sort of health insurance plan they have to pay regularly. Having insurance covers the costs you otherwise have to pay in full amount. With a health insurance, you can get it for free, at a discount, or you get reimbursed. This is very important since medical bills can be very expensive, especially when you get an operation or something. There are different types of health insurance, one of which is the PPO.

PPO or preferred provider organization health insurance plan is a little different from the traditional plans. It is more like the HMO or health maintenance organization with the fact that it has a network of service providers who can give you the treatments necessary. It includes some hospitals (because some hospitals have higher fees than others), medical labs, and of course a network of physicians. However, the PPO has higher rates than HMO, but less than the regular plans people usually have.

Some insurance plans cover all the medical fees of a patient, no matter how unnecessary it is. You don’t have to pay for anything. However, the PPO doesn’t work like that. You have to pay for the whole medical bill at first, but it will be reimbursed in the end. The deductible depends on the plan you have with the PPO insurance, but usually it would be about 80%. That is if you go to a physician within the approved network. If not, the deductible would probably be about 50%. The change could be great, which is why you have to check with the network before going to a physician.

The PPO plan is a more complex kind of health insurance. There are plenty of advantages with this type of plan. One of the main advantages of PPO is that it gives you more freedom than HMO gives. With the HMO, you can only go to the approved physicians. But with PPO, you can go somewhere else without waiting for the approval of the insurance. This is beneficial when your case needs immediate attention or a special care. But as I said earlier, you have to pay for it first before getting reimbursed after claiming it.

PPO has a large network of physicians to choose from. You just have to choose an insurance company which has lots of connections who are good and at the same time, near your location. Even if you have the choice of going somewhere else, it would be less expensive to get an in-network physician. This is great for those who have rare diseases, since the network is broad. And in case your preferred doctor isn’t included, you can still partly reimburse the costs. PPO doesn’t really require you to choose a primary care physician, since they will still cover the cost anyway.

But with these benefits are disadvantages, one of which is the cost of the insurance plan. The cost of PPO plans is generally much higher than HMO plans, although the latter has a more limited coverage. However, there are several kinds of PPO plans to choose from. The deductible rates differ and the higher deductible, the lower premium you have to pay. You really have the freedom to choose here.

You have to think a great deal about the issues that concern the different types of health insurance plans available today. Which among PPO, HMO, or the regular plans is the best for you in the long run? Don’t just think about your present situation, because an insurance plan usually lasts a lifetime. You’re making a commitment once you’ve decided on one plan. Not doing so could cost you more money.

Also, take note of the money you have and the risks you have of getting sick. Don’t get an expensive insurance if you don’t make that much money. Check your lifestyle too, to see what possible illness you might get in the future. The most important thing is still prevention, but if it’s inevitable, you still need to go to the hospital and having an insurance to back you up is essential.

Insurance is really important today. Some people take it as a burden they have to bear because it’s required by the state. But for others, it’s a way to save money because they can’t afford to pay for the medical bills that are always too high for their own good. To make the most out of your insurance, you have to choose wisely.

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