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eLearning Series:
Your Most Popular Insurance Questions
Answers For Health and Home
Insurance
( 50 articles
in this series )
PPO (Preferred
Provider Organization):
What Does It Mean?
PPO stands for Preferred Provider Organization.
These organizations have contract agreements with the insurance
companies. A PPO's big advantage is the rules are a
little more relaxed than an HMO which means they tend not to
be so
restrictive. Fewer restrictions usually help the consumer,
which is a good thing for you.
PPO’s
allow you to see whichever doctor you like. This is
a huge advantage to many people, especially the elderly and
those with young children. Repetition is very important to
those with children and the elderly since they usually feel
more comfortable going to a doctor they trust and will tend
to be more open with that doctor or hospital. If the patient
chooses and out-of-network physician, they will have to pay
a higher out-of-pocket expense but doesn't need a referral
to see a specialist.
Many times life’s financial situations determine our choices
and health care is no different. HMO's are a lot cheaper but
if you want input into your healthcare choices and the services
you will be receiving then the best choice is a PPO. PPO’s
give the consumer basically total control over his or her needs
when it comes to their health.
PPO's
were created originally to give a big group lower rates
for health care coverage and to gain a growth in business for
their organizations. Many reasons that PPO's have been so successful
are the many things that they have been able to do within their
organizations. A lot of times second guessing is never needed
with a PPO, as more detailed information is available to PPO
doctors. This helps cut down the costs for medical insurance
for the group of a PPO.
Many PPO's were credited with reducing the rapid rise of medical
expenses in the 1990's, however with expansion, a lot of PPO's
joined each other to make larger companies, which doesn't necessary
help the health care consumer. PPO's usually require insurers
to pay a claim in a certain time frame to be eligible for the
PPO discount. PPOs goal was to make things simpler
but now it seems maybe the opposite is true. PPO's have great power
in getting cheaper prices for their customers in the already
complex health care system in the United States.
Let’s
now look at some common rules and questions many people
have about PPO's. One of the most common questions people ask
is “What if there isn't a provider in my area?” Under most
PPO plans you are given the standard benefit for someone who
is local. Prescription drug programs are covered in PPO's and
have two different coverage options. One is to get them at
your local pharmacy and the other is to search online and purchase
them.
Many people don't realize, and this is probably one of the
more important rules of a PPO, certain services must have prior
approval before the service is rendered. One reason for this
is that there is nothing more horrible than going through an
operation and finding out after recovery that without prior
approval no payment will be made. Doctor visits which use the
co-pay option is another reason people love PPO's.
PPO's
also have a yearly deductible which basically
means even though you have a co-pay there is a certain
amount you
must reach before they PPO will start paying for the medical
fees. Most PPO's will pay 80% of the medical bills as long
as you use the in network physician. PPO's offer flexibility
that other plans just can't offer you. Usually the overall
premium is cheaper for PPO than it is for other traditional
plans and also for health insurance. One important thing to
remember is any work done outside the network will cost you
a lot more money. It's best to try and fine providers close
to you or in the network.
So if you want to control more of your health care decisions
then a PPO is probably one of the best choices for you and
your family. PPO's are a natural choice for most Americans,
it could be the best choice for you too.
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SolveYourProblem.com : 2005
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