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PPO Insurance (Preferred Provider Organizations)

As managed care systems, PPO health insurance plans are very similar to HMO plans. These types of medical insurance plans provide health care for their members by contracting with selected hospitals and doctors, much like an HMO. However, unlike an HMO, many PPO programs will cover non-network providers if you pay a larger co-payment or deductible.

What is PPO Insurance?


A PPO is a Group of Doctors

Doctors within the PPO network only provide care to a specific group. The PPO may be sponsored by a health insurance company, an employer, or a group of employers. The health insurance group trades the increased patient number for a discounted rate from the health care provider.


PPO Insurance is a Reimbursement Program

With a PPO insurance plan, you will probably pay for your health care services and be reimbursed by the health insurance company. Often the doctor will send the bill to the health insurance company for you. The reimbursement that you or you doctor get will depend on the policy's co-payment and deductible, which are subtracted.

Advantages of PPO Plans Disadvantages of PPO Plans
Choice of doctor
PPO networks tend to be much bigger than HMO networks. If you do see a non-network provider, the majority of PPO plans will still cover a portion of the cost (it will be less than they would pay for an in-network provider).
More Expensive than HMOs
PPO plans are generally more expensive than HMO health insurance plans as a result of the flexibility they offer.
No Primary Care Physician Gateway
You probably will not have to designate a PCP or obtain referrals before you can visit a specialist if you are a member of a PPO.
More paperwork
PPOs often require more paperwork than comparable HMO plans. Customer service and billing problems are often more frequent with PPO plans as well.
Better Coverage for Chronic Conditions and Non-traditional Medicine
People with chronic conditions such as back pain, allergies, and arthritis tend to be more satisfied with PPO plans. A PPO could also cover non-traditional treatment such as chiropractic care or acupuncture.

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