What is a PPO?

What is a PPO?

A PPO (Preferred Provider Organization) is a managed healthcare system popular throughout the United States. Similar to its cousin the HMO, Health Maintenance Organization, PPO’s provide a high level of healthcare, as well as a variety of medical facilities available to all participants.

Unlike the HMO however, a PPO is actually a group of doctors and hospitals that work under one umbrella (called the PPO), to provide medical services at a discount to the PPO participants. By granting discounts to the participants via an insurance company, the insurance companies are able to entice people to join the PPO by offering financial incentives. These incentives may include: greater discounts for medical services performed by in-system doctors; lower deductibles and lower co-payments.

Also different from traditional HMO’s is that PPO users pay for services at the time of the visit and are reimbursed some of the cost by the health care provider at a later time (though many PPO doctors prefer to invoice the healthcare provider directly). The percentage of reimbursement depends on the healthcare policy, a previously established rate agreement, and whether the doctor/hospital is within the PPO network.

Unlike the HMO systems, PPO participants may utilize any doctor they wish, and are not required to select a primary care physician (PCP), and do not require authorization from that PCP before the enrollee seeks medical assistance for any ailment or malady. However, PPO enrollees are urged to select doctors within the PPO system, by way of higher reimbursement and lower co-payments.

The disadvantage of a PPO healthcare system is the out-of-pocket expense to the enrollee. Because a percentage of each medical visit rests on the shoulders of the participant, the overall cost of a PPO is much higher than the fixed costs associated with HMO’s.

If you are looking for quotes on PPO health insurance, give Qooqe.com a try and you can get instant online quotes for your needs. PPO’s can provide great healthcare coverage to many families in the United States, but as with any healthcare policy, be sure to research the plan thoroughly to determine what type of coverage is best for you and your family.

2 Comments

  1. I will be active with mcare services part a/b in march 2015 thru ssi. I am interested in looking into both hmo/ppo options thru the mcare advantage options list of contacted provides.
    Would you have a list of ins options with plan coverage ded out of pocket coins coverage options?

    Reply

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