Preferred Provider Organization PPO

With a PPO, you may have:
  • A moderate amount of freedom to choose your health care providers — more than an HMO
  • Higher out-of-pocket costs than an HMO
  • More paperwork than other plans if you see out-of-network providers
  • The ability to manage your own health care
What doctors you can see. Any in the PPO’s network. You can see out-of-network doctors, but you’ll pay more.

What you pay.

  • Premium — Your monthly payments are based on the negotiated rates PPOs have with their network providers.
  • Deductible — Some PPOs may have a deductible. You may 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 $15, you pay when you get care. Coinsurance is when you pay a percent of the charges for care, such as 30%.
  • Other costs — If your doctor charges more than others in the area do, you may have to pay the balance after your insurance pays its share.
  • Paperwork involved. 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.
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