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What does ppo mean in health insurance

what does ppo mean in health insurance

HMO and PPO plans develop from balancing financial and service options. The more expensive plans can vary in their features, i.e. a higher priced plan can mean more services are covered. It can mean that the plan pays a larger portion of the cost for covered services. It can also mean that deductibles and out-of-pocket maximums are more favorable to you.

BEST PRODUCTS helps you sort through all the variables and know just what is most important to you.

HMO - Health Maintenance Organizations

Choosing an HMO usually means that you agree to use a specific team of health care professionals. In most cases you select one doctor, from a list of the members, who will serve as your Primary Care Physician. This physician now coordinates all of your health care, which means that he or she treats you directly and, when necessary, manages your referral to specialists. The only exceptions to first going to your Primary Care Physician is for visits to an OB/GYN or in an emergency.

Some HMO's are becoming more flexible with the above structure and BEST PRODUCTS is happy to educate you on the variations that can make the difference in your choice of HMO health insurance.

Primarily the highlights of HMO insurance include:

Lower out-of-pocket expenses.
  • No deductibles or plan limits.
  • Low cost doctor office visit co-pays of $5-$15.
  • Usually no or very low hospital deductibles.
  • No paperwork or claim forms.
  • Pre-existing conditions may be covered.
  • More comprehensive coverage.
  • Limited choices of doctors and facilities.
  • If you were to travel out of

    state, you are covered for

    emergencies as if you were in the network.

  • PPO - Preferred Provider Organization

    Choosing a PPO in most cases means having the ability to use any doctor or facility you choose, although the benefits are higher when you use one of the physicians or facilities that belong to the chosen PPO organization. All doctors and hospitals within a PPO network have agreed to accept a discounted fee for their services from the plan.

    It is possible to find, from some providers, a broad range of available individualized choices within the above framework. It is important to know all your options before signing for your future medical protection and BEST PRODUCTS is here to assist.

    Primarily the highlights of PPO insurance include:

    You may go to any doctor in the network at any time without a referral, including all specialists.
  • A co-pay at the doctor's office of $10 - $45.
  • You may go out-of-network "at will" to any top specialist for your serious problems.
  • No claim forms or paperwork
  • Choice of deductible.
  • Prescription coverage is included.


    The choices are many. One must take the responsibility to know what needs are required, what needs may be required, what financial considerations exist, and which health insurance options are best suited for all of the above HMO vs. PPO discussions.

    BEST PRODUCTS will guide you through it all. Simply contact us and we will be pleased to assist you in identifying the best product for your medical and financial security.



    Category: Insurance

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