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What is Preferred Provider Organization (PPO)? – Health Insurance

A preferred provider organization (PPO) is the closest to an indemnity plan, which typically allows you to see any doctor. PPO insurance plan is developed to combine the lower cost of managed care with a greater degree of choice found in traditional health insurance.

A PPO health insurance plan operates like an HMO but the greatest difference is, that under a PPO insurance plan, a primary care physician is not required. As a result, seeing a specialist does not require a referral.

Advantages of Preferred Provider Organization (PPO)

  • Health care costs are low. The standard co-payment is $10.
  • You may go to any specialist without permission, as long as the doctor participates in the network.
  • A primary care physician is not required.
  • Paperwork is not your responsibility.

Disadvantages of Preferred Provider Organization (PPO)

  • Paperwork is your responsibility if the care is non-network.
  • If you see an out-of-network doctor, you might have to pay the entire bill yourself, and then submit it for reimbursement.
  • Co-payments are larger than with other managed care plans. 
  • You might have to pay a deductible if you choose to go outside the network or pay the difference between what network doctors and out-of-network doctors charge.

Cost of Preferred Provider Organization (PPO)

It’s expensive of all. In addition to your monthly or quarterly premiums, the standard co-payment is $10 for a routine office visit during regular hours If you need or want health care from outside the network, you should expect to pay a higher co-payment.

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