The Preferred Provider Organization Plans (PPO) is a type of health insurance that requires the policy holder to pay a copayment each time they pay a visit to the doctor. For example, if you want the insurance company to pay for your medical cost, you have to pay a copayment after you submitted the bill. The policy holder also has to pay for an annual deductible. The insurance company will pay for the majority of the medical fees. Most of the time, the insurer will pay 80% of the medical bills while the policy holder pay for the remaining.
The policy holders are required to use the service of a doctor in a network. If you choose to hire a doctor outside the network, you have to pay for a higher deductible. Patients who hire an out of network doctor will have to pay for most of the medical bills. The doctor in the PPO network may prescribe the medicine at a lower cost. If you use the doctor in the network, your medical cost will be much cheaper than the standard health coverage. Unlike indemnity plan, the doctors in the network are from different states in the United States.
The coverage of a PPO plan includes surgery, maternity care, allergy, and office visits. If you choose to hire a participating doctor, you don’t have to file paperwork or pay for the balance billing. Members who do not want to use a Primary Care Physician (PCP) don’t have to get permission.