In Preferred Provider Organization (PPO), you can avail medical benefits while your health care is managed. You are given a choice of health providers and you can choose from them. In this system also, you need to pay a fixed monthly premium and the insurance company agrees to pay for your medical expenses.
However, unlike the HMO system in PPO plan you need not see a primary care physician first. You can see a specialist physician without the referral of a primary physician, thus making specialist care more convenient.
In PPO plan, you can avail medical care from a doctor or hospital outside their network, by paying a higher copayment. However, the paperwork and formalities for claiming the insurance lies on you and you have to meet the guidelines stated by your insurance plan. Cost of treatment in case of hospitals outside the network may be more expensive.
You need to know
As there are services that you can choose from, it is imperative that you are well informed about the details of your plan. You need to know about:
- The doctors, their professional details and their clinic details
- The healthcare services that are covered
- The network physician and hospital details
The non-network physician and hospital details, i.e. payment, deductibles, copayments, etc