A Preferred Provider Organization or a PPO is a group of doctors, hospitals, and other medical facilities that provide health care at reduced rates to the insurer???s and plan administrator???s clients. Insurance companies sometimes require you to use only the members of the PPO network they are associated with. They can deny claims or require higher co-payments if you visit a provider outside the network.
By using these networks that offer services at pre-negotiated discounted rates, insurance companies keep their costs low. This can also help insurers get more for their plan limits and stretch their coverage while keeping the out-of-pocket costs low. Using a network provider who is familiar with the billing procedure of the insurance company increases the chances of having the charges billed directly to the insurance company, making it a cashless transaction for the insured.
When you are looking to purchase a visitor medical insurance plan, you must first find out if the plan follows a PPO network. Look for service providers in your area who fall under the network. Find out the penalties for using providers outside the network. Become familiar with pre-certification and pre-notification procedures to avoid a reduction in benefits.