Understanding Your Ppo Plan
It is not surprising how badly people get confused by their health insurance coverage. Even determining the type of plan that you have is not always immediately evident. Most people that have health insurance as a work benefit will have either PPO or HMO type of insurance. If your have PPO it stands for Preferred Provider Organization. The organization itself consists of nearby hospitals, clinics, doctors, and others that make a provider group.
It is necessary for you to stay within this particular group of doctors, clinics, and hospitals to keep from paying for extra charges. It works out for the insurance company when you visit these particular providers because it is cheaper for them, they pass the savings on to you. Usually there is a set fee when you visit a caregiver from within this group. When you go and see a provider that is outside of this group then you will have to pay a percentage of the charge and that can get expensive.
Now to show this in an example, let's say that you go to a PPO provider for a regular exam which will include blood work and perhaps another health screening as well. The cost of the visit is $200. You will pay a fee for this visit the same as for any other visit a flat fee of $15. If this doctor is not in your plan then you may wind up paying 40% of that visit amount which would be $80. By going to an out of network provider you have very simply reduced your benefit amount towards the exact same service.
Because reading over insurance information is hard to understand, often people have no idea that they have a PPO plan and then when these people switch jobs they will get a surprise the next time they visit their regular doctor. That same doctor may not be on the list of preferred providers and it will cost much more than they are used to. Instead of getting an unhappy surprise it is important to take some time and read over your documents before going to see any health professionals, or switching to a new plan.
Many times you don't need a new insurance plan but just need to understand the best way to make the most of the health insurance that you do have. If you have an PPO plan then it is advisable to choose from their list of health care providers to maximize your benefits and minimize your out of pocket expenses.
It is necessary for you to stay within this particular group of doctors, clinics, and hospitals to keep from paying for extra charges. It works out for the insurance company when you visit these particular providers because it is cheaper for them, they pass the savings on to you. Usually there is a set fee when you visit a caregiver from within this group. When you go and see a provider that is outside of this group then you will have to pay a percentage of the charge and that can get expensive.
Now to show this in an example, let's say that you go to a PPO provider for a regular exam which will include blood work and perhaps another health screening as well. The cost of the visit is $200. You will pay a fee for this visit the same as for any other visit a flat fee of $15. If this doctor is not in your plan then you may wind up paying 40% of that visit amount which would be $80. By going to an out of network provider you have very simply reduced your benefit amount towards the exact same service.
Because reading over insurance information is hard to understand, often people have no idea that they have a PPO plan and then when these people switch jobs they will get a surprise the next time they visit their regular doctor. That same doctor may not be on the list of preferred providers and it will cost much more than they are used to. Instead of getting an unhappy surprise it is important to take some time and read over your documents before going to see any health professionals, or switching to a new plan.
Many times you don't need a new insurance plan but just need to understand the best way to make the most of the health insurance that you do have. If you have an PPO plan then it is advisable to choose from their list of health care providers to maximize your benefits and minimize your out of pocket expenses.
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