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PPO Coverage

Preferred Provider Organization

PPO Coverage2019-01-08T08:16:40+00:00

PPO Explained

A PPO is a Preferred Provider Organization. This is a select group of doctors, medical offices, and even laboratories joining together to provide health discounts when a patient visits this group. Similar to a discount club, the best benefits are solely within the PPO network. A PPO is a managed care plan and provides more flexibility for those who like to have lots of options.

Perks of PPO Plans

One of the best parts about a PPO is it gives people more freedom to make choices. Any provider within the network can be seen, and a primary care provider is not assigned nor required. A person can choose any doctor they want to see. Additionally, second opinions and specialist’s appointments do not need referrals; they can be made on an as-needed basis.

Co-pays, specific set cash amounts, are paid at appointments and minor procedures, so you will know how much payment is required in advance. A PPO allows members to visit out-of-network providers. This gives more flexibility for those who live in smaller towns, or for those who want to have medical care when traveling to locations outside of the network.

Points to Notice for PPO Plans

PPO plans can be more expensive than other programs. When compared with an HMO (health maintenance organization) the monthly premiums are higher. A deductible has to be met before the PPO plan starts paying. It differs from Comprehensive Health Coverage as alternative providers (such as osteopathy and acupuncture treatments) are traditionally not in the network.

Benefits, after the deductible is met, are paid at varying levels for out of network providers. The deductible can be higher, fewer benefits paid, and increased costs can occur when going out-of-network. Additionally, co-pays are more expensive.

Scheduled surgeries and procedures require pre-approval from the managed care PPO.


he PPO provides greater freedom and more control over choices for your health. It is important to consider your financial and medical needs when deciding to purchase a PPO to make the best decision for you.

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