Summary
Advantages:
- Unlimited Choice of Doctors
- Premiums
- Limit on costs
Disadvantages:
- Out-of-pocket costs
- Paperwork
- Benefits
Disadvantages of PPOs
Patient Out-of-Pocket Costs
- Although PPOs have less expensive premiums than indemnity plans, they have more than managed care type plans such as HMOs, or POS plans.
- If non-network providers are used, the other out-of-pocket costs would be the same as under an indemnity plan.
- If network providers are used, the deductible is usually lower as your share of co-insurance payments.
Paperwork
- The amount of paperwork depends on whether you are using non-network or network providers.
- With non-network providers, there is no difference from the indemnity type health plan. Paperwork will be less with contracting providers, but there will still be an Explanation of Benefits to show how much you owe the provider.
Benefits
- Only a few preventive services are covered. Even those are only covered if provided by contracting health care providers.
Advantages of PPOs
Unlimited Choice Of Doctors : Like Fee-For-Service (Indemnity) plans, there is total freedom of choice of what doctor and other health care provider to see and when, as well as what treatment to receive and where.
Premiums: Premiums are usually less expensive for a PPO plan than a Fee-For-Service plan but more expensive than a managed care plan such as an HMO.
Limit on Costs: If a PPO provider is used, there is no worry that the charge will be higher than the plan allows. Because the provider and the plan have agreed in advance on the fee, you will never pay more than your percentage of the contracted fee. Usual, customary and reasonable is not an issue as long as you use network doctors and facilities.
To Learn More
More Information
HMO