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| *Ostroff, Fair and Company>>>Insurance |
Health insurance.....? |
my place of work just change our insurance to a PPO...what is that..is it like an HMO?...god i hope not... PPO (Preferred Participating Organization) means that you can go to medical professionals within the Organization and receive care at a pre-negotiated price. If you go outside of this organization of medical professionals you may owe the whole amount. The mis-conception is that with these policies you can see anyone, but in reality most PPO's in the USA will pay little or nothing for services outside of contracted physicians or hospitals. Most PPO plans have Deductibles and also Co-insurance, when purchasing one ask what the max. out of pocket is (the amount when you stay within the network of physicians would be the most you would pay in one calendar year) Ex. if you have a 250. deductible 80/20 plan this means that when you see a doctor for x-rays and diagnostics you would pay the first 250.00 once this amount is paid you will also pay 20% of the charges up to the max. Every year this starts over, in the USA employers and Individuals are purchasing higher deductible PPO plans these are becoming popular because they are much much cheaper (in most cases 40-60%). HMO (health maintence organization) with these type of plans you first pick a primary care physician who receives pre-payment for services. In essence you are paying ahead of time to see the doctor, these types of plans are now very expensive since you are paying for services upfront. Visit your health insurance companies website for the doctor listings, and I would suggest calling ahead to verify that the doctor is still ont he Preferred Participating physician, they are constantly changing. Ultimately you do not want to end up with a big bill. No, with PPO you have the choice to go to whatever dr you like PPO is way better than HMO, you are lucky! be happy and stay healthy no matter what They are not alike. The HMO is a controlled program where you need referrals for specialists and have to maintain a PCP (primary care physician). There are POS (point of service) programs that run off the PPO (preferred provider option) network that are like HMO's but a PPO plan does not work the same. A PPO allows you to see any doctor within the network or out of the network and you may see a specialist without a referral. HMO's typically do not have a deductible, but a PPO may based on your employers contract. An HMO typically pays at 100% of allowance, where a PPO may not (look at your benefits booklet supplied by your employer). You may also go out of network for a lower benefit level (maybe in network pays at 90% where out of network pays at 70%). They have 2 different types of PPO policies, one is a 'premium' where they have to stick to state mandates; the other is a self funded group where they pick and chose. Another thing to watch is PPO's may not have things like wellness benefits (physcial, pap, routine labs) or a $$ max, HMO's typically do have this coverage. It is always recommended that you check that services are covered before you have them done (you can get the procedure codes and diagnosis codes from your health care professionals) with ppo's you have more freedom, as far as which providers you can see. There are usually more out of pocket cost with ppo's. You may have a deductible, which is a dollar amount you may have to pay before any of your benefits can be paid out. Second you may have a co-insurance, which is a certin percentage (usually 5-30 percent) of the bill is your responsibility. |
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