Health Insurance: Understanding Ppo's

Thinking about joining a PPO? Find out how they work and if one is right for you by reading this informative article!

PPO's, or preferred provider organizations, are one of the least expensive health care insurances you can get. It's much like other health insurance coverage in that the company charges you a monthly premium. That premium gets you and your family a certain level of healthcare coverage. It sounds easy, doesn't it?

Now, here comes the details: A PPO is made up of a network of providers. These providers are medical doctors, dentists, specialists, hospitals, et cetera. In order for your and your family's medical services to be at least partially covered by a PPO that you're a member of, you must visit one of their providers. You will be required to pay a low co-payment, usually around ten dollars, and the rest of the bill is paid for by the PPO.

If you choose to visit a healthcare provider or a hospital, et cetera, that is not in the network, then you will be required to foot the entire medical bill. You can then turn the bill in to your preferred provider organization. After you reach a certain amount, the PPO should reimburse you for a portion of the bill. Normally, a PPO will repay you eighty percent of the bills you submit... if the price of the treatment you or your family received is considered to be "reasonable". If the PPO considers the bill to be too high, it will only pay a certain amount. You'll have the responsibility for paying the remainder of the bill.



Therefore, if you need a medical service, and you can get it performed through one of the PPO's providers, you'll end up paying around ten dollars even if the bill is a thousand dollars. On the other hand, if you decide to choose a provider that is not in the organization, you'll have to pay the total thousand dollars to the healthcare provider. Then, you can turn the bill in to the PPO. If you have your deductible met, you can expect to receive a reimbursement for eight hundred dollars.

Do you see the advantage of choosing a provider that is included in the organization? The medical treatment in this example will either cost you ten dollars or two hundred dollars.

Another advantage in having a preferred provider organization to provide your medical insurance coverage, is that you do not need a referral from a doctor in order to arrange a visit with a specialist.

In order to completely understand a preferred provider organization, you'll need to realize that it has its pros and cons. PPO's usually have the lowest premiums; you have the freedom to be treated by any doctor, dentist, hospital, et cetera, treat you and your family; you can even choose a specialist on your own without needing a referral. But, keep in mind of the higher cost in choosing your own healthcare provider; plus, the paperwork and all associated forms are your responsibility if your provider isn't in the network; the providers within the network might not be in close proximity to your home.

Finally, just make sure that you consider all of your options before you sign up for a PPO or any other health insurance provider.

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