Preferred
Provider Organizations
Preferred Provider
Organizations have a network of doctors that insured
can choose from. They also have the option of choosing
a doctor outside of the network for medical care,
however, deductibles and larger co-payments will be
required if a patient chooses a doctor outside of the
network.
Some people prefer
the ability to choose their own doctor, without the
limitations of a Health Maintenance Organization.
However, the doctors within the network determine
reasonable charges. If a doctor outside of the network
charges a higher fee, the insurance company will only
pay a percentage of the in –network charges. The
insured would be responsible for their coinsurance as
well as the difference between the price charged and
the reasonable fee within the network.
The advantages
of a PPO:
- Insured
can choose their own doctor, from within or
outside the network
- Limits
to out-of-pocket expenses for the insured.
The
disadvantages of a PPO:
- Out-of-pocket
fees are more for using an out of network
provider.
- There
may be a deductible.
- Insured
normally needs to complete paperwork to be
submitted to the insurance company.
By Eileen Bailey
See
also:
Understanding
Health Insurance
Major Medical
Health Insurance
Health Maintenance
Organization (HMO)
POS (Point of
Service Health Plan)
Health Insurance
Terminology
|
