Health Insurance Articles

The Advantages Of A PPO Managed Health Care Plan

2011-09-17

Why should you select a preferred provider organization as your health care plan? There are several reasons, especially including your ability to select providers from within a list of approved health service providers.

Why should you select a health care plan at all? There are plenty of advantages of a health care plan are. It covers all of your health care needs with one contact point, frequently including prescription drugs. It generally covers preventative care as well as when you are sick. It is less expensive than health care where the patient selects each provider separately.

Once you have decided to use a health care plan, there are still decisions you must make regarding which plan to select. The first decision is what kind of health care plan you wish to join. There are: HMOs - Health Maintenance Organizations, PPOs - Preferred Provider Organizations and POSs - Point of Service Plans.

What is a PPO and why should you select it?

A Preferred Provider Organization is a health care plan that is comprised of doctors, hospitals and other health service providers. They have agreed to be members of the PPO and to provide medical services at a lower cost. The program allows you to select from within a list of providers the physician that you wish to use. It is a more flexible plan than a standard HMO and is valuable to the patient that has already selected a physician who is not in standard HMO groups but is in a PPO list of providers. The PPO does not use a "gatekeeper" system where every access to a health care specialist must be controlled and authorized by a primary care physician.

The PPO is a program that provides a list of the in-service providers and negotiates rates that are substantially less than the open market rate. This saving is reflected in the cost of the patient's premiums.

You can select your doctor but you can also select any specialists, hospitals or other covered services from within the organization without getting a referral. PPO's will commonly allow the patient to select out of plan physicians but those will cost the patient a higher co-payment and may require the patient to pay for the service and apply for reimbursement.

As with most health care plans, any planned, non-emergency health services requires a pre-approval before the PPO will consider paying for the service.

Although it may be somewhat more expensive than many of the standard HMO plans, for many patients, a preferred provider organization health care plan can be the best alternative. It allows flexibility selecting your primary doctor as well as specialists as they are needed to address special problems or conditions.