Surprise medical bills are crushing the American people. In fact, 20% of patients receive a surprise medical bill after elective surgery. They go into surgery understanding the costs and then are blindsided by additional bills.
Signing up for a Preferred Provider Organization (PPO) is one way to fight back. This type of health care plan offers you more flexibility.
Are you searching for the best health insurance plan for your family? Read on to explore the benefits of a Preferred Provider Organization.
What Is a Health Maintenance Organization (HMO)?
Before we dive into a PPO, it is important to understand HMOs. In an HMO, you are joining a network of doctors and medical facilities. Each provider has a contract with the HMO.
However, you are restricted to this medical network for diagnosis and treatment. Your health insurance does not cover out-of-network expenses. While your monthly premiums may be lower, you are vulnerable to expensive surprise bills.
What Is a Preferred Provider Organization?
A PPO is a type of health care plan that allows you to see any doctor. The primary benefit of a PPO plan is flexibility. You can visit an out-of-network doctor and still receive partial coverage.
The coverage amount is a pre-determined percentage in your policy declarations. The arrangement is called coinsurance, which means that you and the insurance company share costs.
For example, you may see PPO plans with an 80:20 coinsurance rate for in-network doctors. This means that the insurance company pays 80% of allowable costs. You are responsible for the remaining 20%.
The coinsurance rate is going to drop for out-of-network providers. The end result is that you are responsible for a greater share of the medical costs. However, partial coverage for out-of-network is a substantial improvement over an HMO covering zero.
What Are the Benefits of a PPO?
Besides out-of-network coverage, there are many other benefits to a PPO. For instance, you do not need a referral from a Primary Care Physician (PCP) to see a specialist. This is not the case in an HMO plan.
In a PPO, you do not need a PCP. This saves you time and money. Consider that you are having chest issues.
In an HMO, you need to schedule an appointment with the PCP first. You will make a copayment and then get instructions from the PCP for what’s next.
A PPO plan cuts out the middleman. Now, you can immediately set up an appointment with a cardiologist. You do not need a referral and can get straight to the issue.
Lastly, a PPO reduces the impact of surprise medical bills. It is difficult to track all the doctors and tests during a hospital stay. Even if a provider is out-of-network, at least you have some coverage.
Signing Up for a PPO: A Recap
A PPO is a great alternative for people who do not like restrictions. Some people are willing to pay a little more in monthly premium for added flexibility. PPO members enjoy skipping the PCP referral process.
If you are interested in joining a Preferred Provider Organization, contact us today to speak with an insurance specialist.