How to Choose a PPO
Make sure the doctors you need are covered under the plan., Look at what health conditions the provider covers., Consider what procedures the provider covers., Compare the PPO plan with other kinds of coverage (HMOs, for example)., Ask questions.
Step-by-Step Guide
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Step 1: Make sure the doctors you need are covered under the plan.
While PPOs typically have more extensive networks than HMOs, it is important to see if any of your preferred providers are not on the list.
With some doctors that you see only once a year, you may be willing to switch.
But with a doctor or therapist you see regularly, you may want them to be in-network, as that can save you a lot of money.Typically you should ask the provider and look up the information through your insurance's online service (assuming it provides one).
However, you may need to navigate certain hurdles after the initial questions if your doctor is part of multiple medical groups, if the doctor but not the clinic is covered, or if the doctor accepts different insurance at different practices.You can find out if your doctor is in-network if you look up the doctor on your insurance website.
You can also ask the doctor's office. -
Step 2: Look at what health conditions the provider covers.
Some plans don’t cover hearing aids or hearing loss, for instance, while others do.
In any case, if you have particular needs, you should take a look at what each plan covers.
It could save you a lot of money in the long run.You should consider whether your provider covers prescriptions, testing supplies, or other potential medical products specific to your conditions. , Just as with conditions, what procedures a plan includes is vitally important.
Some PPOs don’t cover tonsillectomies, for instance.
While you may not know what you might need in the future, talk with a doctor to determine your potential need for a particular procedure and consider the PPO’s plan., There are several advantages to having a PPO plan, such as being able to choose your own doctor without having to go through your primary provider.
In terms of in-network coverage, PPOs tend to have more options than HMOs.
Knowing how PPOs compare both with each other and with other kinds of plans will help you make the best decision for you and your family.
Other types of plans besides PPOs are described below:
An HMO (Health Maintenance Organization) is a provider plan that has more limited options than a PPO.
It also is more focused on prevention and may require you to live in a particular area to be eligible.
An EPO (Exclusive Provider Organization) is a plan where you are only covered if you go to in-network doctors.
Emergencies are excepted.
A POS (Point of Service) is a plan where you may pay less for in-network doctors for care, but it requires a referral to go to a specialist, whereas PPOs do not. , Before deciding on a plan, you'll want to talk to the insurance provider.
Some of these questions would include what the plans cover ("Does the plan cover newborn care?" or "Does it cover prescription drugs?"), how much it costs ("What is the premium? What's the out-of-pocket maximum?"), and what doctors and hospitals it covers, ("Is my gynecologist, Dr.
Smith, covered?"). -
Step 3: Consider what procedures the provider covers.
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Step 4: Compare the PPO plan with other kinds of coverage (HMOs
-
Step 5: for example).
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Step 6: Ask questions.
Detailed Guide
While PPOs typically have more extensive networks than HMOs, it is important to see if any of your preferred providers are not on the list.
With some doctors that you see only once a year, you may be willing to switch.
But with a doctor or therapist you see regularly, you may want them to be in-network, as that can save you a lot of money.Typically you should ask the provider and look up the information through your insurance's online service (assuming it provides one).
However, you may need to navigate certain hurdles after the initial questions if your doctor is part of multiple medical groups, if the doctor but not the clinic is covered, or if the doctor accepts different insurance at different practices.You can find out if your doctor is in-network if you look up the doctor on your insurance website.
You can also ask the doctor's office.
Some plans don’t cover hearing aids or hearing loss, for instance, while others do.
In any case, if you have particular needs, you should take a look at what each plan covers.
It could save you a lot of money in the long run.You should consider whether your provider covers prescriptions, testing supplies, or other potential medical products specific to your conditions. , Just as with conditions, what procedures a plan includes is vitally important.
Some PPOs don’t cover tonsillectomies, for instance.
While you may not know what you might need in the future, talk with a doctor to determine your potential need for a particular procedure and consider the PPO’s plan., There are several advantages to having a PPO plan, such as being able to choose your own doctor without having to go through your primary provider.
In terms of in-network coverage, PPOs tend to have more options than HMOs.
Knowing how PPOs compare both with each other and with other kinds of plans will help you make the best decision for you and your family.
Other types of plans besides PPOs are described below:
An HMO (Health Maintenance Organization) is a provider plan that has more limited options than a PPO.
It also is more focused on prevention and may require you to live in a particular area to be eligible.
An EPO (Exclusive Provider Organization) is a plan where you are only covered if you go to in-network doctors.
Emergencies are excepted.
A POS (Point of Service) is a plan where you may pay less for in-network doctors for care, but it requires a referral to go to a specialist, whereas PPOs do not. , Before deciding on a plan, you'll want to talk to the insurance provider.
Some of these questions would include what the plans cover ("Does the plan cover newborn care?" or "Does it cover prescription drugs?"), how much it costs ("What is the premium? What's the out-of-pocket maximum?"), and what doctors and hospitals it covers, ("Is my gynecologist, Dr.
Smith, covered?").
About the Author
Natalie Sanchez
Enthusiastic about teaching creative arts techniques through clear, step-by-step guides.
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