PPO Quick and Basic Facts

If you’re thinking about getting health care insurance, you are probably thinking about whether a preferred provider organization, or PPO as they are more commonly referred to, is the right choice for you and your needs.

Preferred provider organizations are networks of doctors and medical facilities that have signed contracts with the PPO. If you are a member of a PPO, you can look forward to some fundamental options.

Some PPO Basic Facts

  • Access to doctors and medical facilities within the PPO network, as well as without. Visits to a doctor outside of your PPO network may result in higher co-pays and less PPO insurance coverage.
  • Choice of a primary care physician. It’s a good idea to have a primary care physician, but it’s optional.
  • Due to various regulatory factors, PPOs are subject to less government oversight than, say, HMOs. This can be either a good thing or a bad thing, depending on your perspective.
  • PPOs tend to cost more than HMOs. Why? Because what you get in greater physician choice you pay for in higher fees and co-pays.
  • With a PPO you can see a specialist for whatever reason without needing a primary care physician’s authorization. This elimination of the middle-man is quite appealing to many people, and creates a greater sense of individual control within a PPO than you would find in an HMO, which is usually highly regulated.

Choosing the right kind of health care system is a loaded endeavor. Before you make a big decision like enrolling in a PPO, make sure you consult with a health insurance expert first. PPOs might be the best match for your needs, and they might not. When it comes to your health care, you want to make the best-informed decision that you possibly can.