Thursday, January 29, 2009

What is a PPO

By Jeff Cline

A PPO (Preferred Provider Organization) is a very popular managed care health insurance product. The benefits this product offers is structured around a network of medical professionals. The benefits are structured around specific medical coverage.

These plans let you choose the medical professionals of your choice. They have a contracted network of professionals that offer negotiated rates for added savings. But even if you go out of the network you still get a reduced benefit to help with the expense.

These plans have a set deductible amount. Typical it is an annual dollar amount. A deductible may be $2000. Throughout the year as you incur medical expenses they will go towards your deductible amount. If you met that the insurance company will start to share expenses with you.

After your deductible is met the insurance company may pay 100% of expenses incurred. But, more often they split the expense up to a certain amount. For example, your benefit may be 80/20 with a co insurance max. Of $2000. So you would be required to pay 20% up to $2000.

Either way they will have an "annual maximum out of pocket" that you would be required to pay. So if you had a $3000 deductible and a $2000 co-insurance max you could pay up to $5000 out of your own pocket before the insurance company paid 100% of expenses.

Most PPO plans have a benefit called a co-pay. A co-pay is a specific amount you would have to pay for certain medical treatments, such as office visits and prescriptions. A co-pay helps offset some of your basic expenses.

Consumers love that with a PPO they can see and medical professional they choose. Even a specialist, without the need of a referral. They can go to a medical professional or facility that is not in network and still get some benefit.

A PPO is very popular and many people are buying them. You will need to know all the PPO facts. We have only covered the basics here. Compare the facts with your situation before making a decision to buy a PPO product. - 15485

About the Author: