What is a PPO?

PPO – Preferred Provider Organization. PPO allows patients to see a specialist without a referral from a Primary Care Physician. PPOs usually have a wider range of doctors to choose from when compared to HMOs. The direct access to specialists is good for people who have chronic illness, or in case of urgent care and emergencies. Patients can get appointments with their preferred specialists as and when required. Usually, a PPO will pay a greater percentage of the cost for a preferred provider and less for a non-preferred provider.

Advantages of PPO:

  • Patient can visit any doctor and hospital. They are categorized as preferred and non-preferred providers
  • PPO covers all preferred providers according to their policy

Disadvantages of PPO:

  • For all non preferred providers PPO covers only 80% of all the expenses, depending on your insurance company rules. And rest has to be paid by you

Points to note about PPO plans

  • Read your policy very carefully.
  • Make sure that you are informed about the doctors and services that are considered preferred and which are non preferred
  • Try to go to the preferred providers, as the PPO plan would give full coverage for them. You will only have to give the co-payment. For non preferred providers your co-payment is higher when compared to the preferred provider
  • Find out the procedure for claims, if any