Should You Take PPO Health Insurance?

Written by Hersh Stern Updated Thursday, November 21, 2024

Basically, there are two types of health insurance Plans: One being Fee for Service health Insurance, and the other Managed Care Health Insurance -of which the PPO or Preferred Provider Organization is one such health net.

Fee for Service: In these plans, the insured patient is examined by a doctor chosen by him, and the medical professional receives a fee for each service given to the insured patient. The fee- for -service health insurance claim is filed either by the patient or the medical provider.

Managed Care Health Insurance Plan: Lot of American citizens have opted for the Managed Care Health Insurance Plan. There are various types of Managed Care Health Insurance Plans working differently, providing extensive and comprehensive medical services to their customers, and offering financial incentives to those insured patients who opt to use the providers listed in the managed care plan. These include:

• The HMO Plan or the Health Maintenance Organization
• The POS Plan or the Point of Service Plan
• The PPO Plan or the Preferred Provider Organization

What Does the HMO Offer You?

The concept of prepaid care is the driving force behind the HMO. It is the oldest form of organized health care. For a predetermined fee, the HMO allows its members recourse to a variety of health care benefits- preventive care not withstanding. In the event of requiring a specialist's services, you would need to coordinate with the primary care physician referred to you by your HMO. In most HMO plans, this would include the concept of co-payment, with reference to medical services provided- including hospitalization and office visits. Here, the insured client would pay his doctor a predetermined sum of money for that particular visit .After the co-payment(an expense-sharing agreement in which the insured pays a particular amount for a certain type of medical service) has been effected, most costs as a result of that visit would be covered. This is exclusive of lab tests.

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What Does POS or Point of Service Signify?

Rather than obtain referrals from primary care physicians, the HMO offers the insured patient the right to the concept of self direct care - a facility normally and commonly observed in indemnity plans. When a HMO offers this sort of "opt-out provision", then it is referred to as a POS or a Point of Service Plan. The client's decision on how to act further at this point of service would have a direct bearing on how this Plan would function.