What are PPO’s?

PPO’s, or preferred provider organizations, are health insurance options that are available to employees of companies that have signed up for this type of coverage. They are similar to HMO’s in many ways, especially in their systematic approach to health coverage, but there are still some key differences that make these plans unique.

Preferred provider organizations are, essentially, give-and-take relationships between companies and groups of medical providers. Physicians, hospitals, and other health care workers provide their services at reduced costs to everyone covered by the PPO plan. In turn, companies promise to provide these medical professionals and institutions with a high volume of patients. Policyholders receive care from these particular entities at low costs, so they have great incentive to visit doctors included in their PPO’s.

Unlike HMO’s, where the health services are prepaid, those covered by PPO plans instead must pay for the healthcare they received at the time of or shortly after receiving treatment. The bills may be paid either directly to the acting physician or through the insurance company.

Patients are not required to visit doctors included in their PPO plans, which gives them more flexibility, but they are encouraged to do so through the very low cost of accepting healthcare from these physicians. Typically, 90% of the costs associated with visiting a PPO-affiliated doctor are covered by the insurance company. However, only 60% is paid by the insurance company, should you visit a non-PPO physician.

Contact Us

If you would like to learn more about PPO’s, or if you would like help in selecting the California health insurance provider and plan that is right for you, then Catherine Michaels Insurance Services can help. Contact us today at 888-875-9888 to speak with one of our agents today.