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PPO Health Insurance Plans

Do you really know how a PPO network functions? Is it best to choose a PPO, an HMO, or a POS network for your health insurance plan? Preferred Provider Organizations (PPO - also sometimes called Participating Provider Organizations or even simply just Network plans), Health Maintenance Organizations (HMO), and Point of Service (POS) health insurance plans all function in different ways. Here are some of the things that you should know about how PPO’s work.

Preferred Provider Organizations provide for substantial discounts to their members when the member utilizes medical services from in network physicians, hospitals, and facilities. A PPO is able to offer a large discount to its members because it has previously negotiated a contract for its members with the different medical providers within the network.

From the medical providers point of view it makes great business sense for them because of the increased business volume that they will see because of the discounted services incentive (most members of a PPO will choose a physician or facility that is “in-network” so as to get the discounted rate).

From the consumers point of view a PPO is great from a cost standpoint because of the discounts. These discounts on medical services can often be quite substantial – especially if one is member of a PPO with a large health insurance company (the larger health insurance company’s have quite a bit of leverage with the Doctor’s and facilities in negotiating a contract because of their many members and the purchasing power that they can bring to the table).

You can imagine that many doctors would think long and hard before deciding not to be a part of the large insurance company’s network (such as a Blue Cross and Blue Shield, an Aetna, or a United Healthcare). This is a great advantage to choosing a large and well known health insurance company as they are typically able to negotiate the very lowest possible rate for its members.

PPO’s are different than HMO’s in some very important ways. PPO’s are much more flexible than HMO’s because of the following reasons:

• PPO’s do not require consumers to choose a Primary Care Physician (PCP) while with an HMO you are required to choose a PCP. With a PPO you can choose any physician that you like and if you decide to change then you can do so any time without every having to seek any special approval. (With an HMO you are often stuck with your PCP even if you decide you want to change or you begin to dislike your PCP).

• PPO’s do not require consumers to get a referral in order to see a specialist while with an HMO you are almost always required to obtain a referral from your PCP before you are able to see a specialist physician. This is an advantage for a PPO over an HMO for 2 big reasons: 1) You don’t have to pay for 2 doctor visits – one for the PCP and one for the specialist 2) It is much more flexible in that you can go directly to the specialist (or even multiple specialists) directly.

• PPO’s will usually cover out of network services while an HMO will almost never cover out of network services. It is best to stay in network for medical care with a PPO because you will enjoy the much lower negotiated rates but subscribers of a PPO will still enjoy health insurance coverage even if they decide to go to a physician or facility that is out of network (with an HMO it is as if you do not even have health insurance if you should choose to go out of network). (Note that most reputable health insurance companies will never consider emergency services as being “out of network” so again be sure and choose a large and trustworthy insurer).

Preferred Provider Organizations are typically the most popular type of health insurance network because of their flexibility. Take a few moments and use our free quote finder to compare health insurance quotes from top insurance companies like Blue Cross Blue Shield, UniCare, PacifiCare, Humana, Aetna, United Healthcare, Assurant, United American, and others that offer PPO, HMO, and POS health insurance plans. Get free health insurance quotes now!