What is a Preferred Provider Network? (PPO)
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A PPO is a type of health insurance plan where members are encouraged to use in-network healthcare providers who have agreed to charge reduced, negotiated rates. Members can visit any doctor without a referral but will pay less when using in-network providers. With a PPO, members are responsible for paying an annual deductible and may have copays or coinsurance. A PPO may be suitable for individuals or small businesses whose employees need flexibility in choosing doctors and do not require referrals to see specialists.
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What is a Preferred Provider Network? (PPO)
- 1. What is a PPO? PREFERRED PROVIDER ORGANIZATION ANGELA CARRIER, PRINCIPAL OF FINANCIAL & BENEFIT SERVICES COMPANY
- 2. Preferred Provider Organization (PPO) With a PPO plan, employees are encouraged to use a network of preferred doctors and hospitals. These providers are contracted to provide service to plan members at a negotiated or discounted rate. Employees generally aren't required to designate a primary care physician, but will have the choice to see any doctors or specialists within the plans network.
- 3. PPO Deductible & Copay Employees have an annual deductible they'll be required to meet before the insurance company begins covering their medical bills. They may also have a copayment for certain services or a co-insurance where they're responsible for a percentage of the total charges of their medical expenses. With a PPO, services rendered outside of the network may result in a higher out-of-pocket cost.
- 4. Who Would Like the PPO Option? A PPO may be a good option for Individuals/families or your small business if your employees: Need flexibility when choosing physicians and other providers Want the burden of obtaining a referral to see a specialist Like the balance of greater provider choice versus lower premiums
- 5. With a PPO You May Have: Premium: This is the cost you pay each month for insurance. Deductible: Some PPOs may have a deductible. You will likely have to pay a higher deductible if you see an out-of-network doctor. Copay or coinsurance: A copay is a flat fee, such as $10, that you pay when you get care. Coinsurance is when you pay a percent of the charges for care, for example 20%. Other costs: If your out-of-network doctor charges more than others in the area do, you may have to pay the balance after your insurance pays its share.
- 6. What About Paperwork? THERE'S LITTLE TO NO PAPERWORK WITH A PPO IF YOU SEE AN IN-NETWORK DOCTOR. IF YOU USE AN OUT-OF- NETWORK PROVIDER, YOU'LL HAVE TO PAY THE PROVIDER. THEN YOU HAVE TO FILE A CLAIM TO GET THE PPO PLAN TO PAY YOU BACK.
- 7. “ ” To learn more about a new plan or review of your existing plan give me a call! Angela Carrier, Principal Financial & Benefit Services Company Email: acarrier@financialandbenefitservices.com Cell: 724-941-8772