What Restrictions Do PPOs Have?

Posted in Health Insurance , PPO

September 25th, 2009

Choosing medical insurance is no easy task because not only are the acronyms for the types of policies confusing, but each one is so different that it may overwhelming just to choose one.

But alas, you must and if you are looking for comprehensive medical care that is cost effective and has a little wiggle room as far as seeing doctors that are not associated with any type of network, then apreferred provider organization or PPO managed health care plan may be for you.

More choices with PPOs

A PPO plan encourages policyholders to stay within the network of contracted physicians and hospitals by enticing the members withfinancial incentive. The copayments to stay within the group of service network providers are extremely reasonable. Members can choose to see any in-network doctor, including specialists, without having to deal with any type of referral system.

Restrictions of PPOs

Compared to the medical coverage provided by health maintenance organizations (HMOs), PPOs operate with fewer restrictions. However, there are some that need to be mulled over before opting into this type of health care plan. The main restrictions associated with a PPO-managed health care plan tend to be associated with cost, money and payment:

• Premiums for PPO plans are higher then other types of managed care plans.
• Policyholders need to pay for their services as they are rendered, complete forms and then get reimbursed.
• Medical expenses incurred outside of the network tend to be repaid at a lower rate of reimbursement.
• Before reimbursements are issued, PPO members typically have to meet a deductible that can be close to $1,000.
• Co-payments for PPO care appoints tend to be more costly.

If you are financially prepared to handle the financial restrictions associated with a PPO managed health care plan, then this type of health insurance may be a good option for you. Make sure to review all the material provided by the insurance company to educate yourself on the costs and restrictions associated with the PPO you are interested in.