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PPOs

Preferred provider organizations (PPOs), which are sometimes referred to as participating provider organizations, are a type of health insurance plan. PPOs provide more flexibility to subscribers than health maintenance organizations (HMOs).

HMOs limit their subscribers to certain doctors and certain hospital locations. PPOs, on the other hand, allow their subscribers greater freedom and flexibility when choosing doctors and hospital locations.

PPO Limitations

Like HMOs, PPOs give their subscribers preferred networks of doctors and hospital locations. However, while HMOs do not allow their subscribers to see doctors outside their network, PPOs offer options for visiting doctors outside their preferred network.

However, despite the fact that this option exists, many PPOs still offer incentives to their subscribers for staying within their network of doctors and specialists. Often, PPOs will charge a higher co-pay for subscribers when they visit doctors outside the PPO's network and a lower co-pay for doctors within the PPO network.

Other times, PPOs will pay a certain percentage of subscribers' doctor bills when they visit doctors outside the provider network. However, in this case, subscribers to the PPO must pay for their bill upfront and submit the bill to the PPO for partial reimbursement. This can be inconvenient for many people, as they have to put cash upfront and wait for re-payment.

PPO Pros and Cons

PPOs provide the flexibility of allowing subscribers to visit doctors within or outside of their networks. While this perk will please some subscribers, it comes at a price. Those who don't mind paying a slightly higher monthly fee and a higher co-pay will find PPOs to be a great health insurance option.

Another positive aspect of PPOs is that, unlike HMOs, subscribers can visit a specialist without a referral from a regular doctor. This can be helpful for people with busy schedules and no time for extra and often unnecessary doctor visits. This can also save a subscriber money, as it results in less overall appointments and co-pays to worry about.

Choosing a PPO

Once you've decided a PPO is the type of plan for you, there's still the matter of deciding on a specific company and type of PPO.

Some people may not get to choose their PPO plan. Employers often only offer coverage under a certain company or under a certain company plan. If this is not the case, make sure you research companies and plans before settling on a PPO.

Some things to consider when searching for a PPO plan include:

deductibles of health care or service
co-pay amount for network providers
co-pay amount for non-network providers
costs of adding other subscribers to your plan (i.e., spouse or dependents)
emergency care and urgent care facility availability in your area
monthly premium costs
number of office locations and doctors in your area both within the network and outside the network
number of specialists in your area both within the network and outside the network
plan limitations and specifics.

Also, personal reviews can be helpful. Ask around to friends and family members. They may have useful information about specific health insurance companies and plans.

You can also find these types of reviews online, but be aware that positive reviews may be hard to find. Often, only the people who feel they have been wronged by a company feel strongly enough to write a review.

To compare companies and plans and get all of the necessary information, request brochures on PPO plans from a few different companies. They will send you literature and easy-to-understand tables that outline their services and prices.

Resources

Quick Quote (2007). Types of Health Insurance. Retrieved October 18, 2007, from the Quick Quote Web site: http://www.quickquote.com/hitypes.html.