10-Facts on PPO Health Insurance Plans

PPO is the acronym for preferred provider organizations. The health insurance coverage is a hybrid of the traditional fee-for-service and a health maintenance organization (HMO) policy. Use the following facts to determine if a preferred provider organization policy is ideal for your medical circumstances:

 A wide variety of health care products and services are covered under the PPO plan.

 Preferred provider organization (PPOs) plans are ideal because they cover preventative care, such as mammograms, immunizations, and other well-being incentives.

 Just as HMO’s require policyholders to select a primary care physician (PCP), the same guideline applies to a PPO plan.

 Certain PPO medical services require a coinsurance and a deductible.

 Most doctors’ visits require a nominal co-payment.

 Preferred provider organizations policies are beneficial for the consumer who wants to maintain a certain level of autonomy over where they receive health care.

 There are eight questions to ask before opting for a PPO health insurance plan:

1. How much are the monthly annual premiums?
2. Which hospitals and physicians are affiliated with the PPO’s network?
3. What is the cost differential between seeing a network PPO and a physician not affiliated with the health insurance plan?
4. What is the PPO’s definition and guideline regarding compensation and coverage for medical emergencies?
5. Which medical products and services are NOT covered under the PPO?
6. What are the coinsurance and deductible guidelines?
7. What is the process for obtaining a referral to see a specialist?
8. Does the PPO cover medical services that are important to you (prescriptions, therapy, specific preventative health programs, etcetera).

 Consumers, who have a general practitioner and prefer medical care flexibility, find the coverage convenience of not being limited to the physicians affiliated with the PPO quite redeeming. The drawbacks are that the subscriber should plan to complete their own paperwork and contribute more to the bill than if they used a physician who belongs to the network.

 Aetna, Blue Cross Blue Shield and Unicare Health care offer provider preferred organization (PPO) plans.

For additional PPO facts for the state of Ohio, Ohio Life & Health provides a wealth of health insurance plan information, advice and Ohio health insurance quotes.

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This entry was posted on Friday, November 6th, 2009 at 9:40 am and is filed under Cleveland health insurance. You can follow any responses to this entry through the RSS 2.0 feed.