Preferred Provider Organization (PPO)

A combination of traditional fee-for –service and an HMO. When you use the doctors and hospitals that are part of the PPO, you can have a larger part of your medical bills covered. You can use other doctors, but at a higher cost.

Questions to ask About PPOs

  • Are there many doctors to chose from? Who are the doctors in the PPO network? Where are they located? Which ones are accepting new patients?
  • How are referrals to specialists handled?
  • What hospitals are available through the PPO? Where is the nearest hospital in the PPO network? What arrangements does the PPO have for handling emergency care?
  • What services are covered? What preventive services are covered?
  • Are there limits on medical tests, out-of-hospital care, mental health care, prescription drugs, or other important services?
  • What will the PPO plan cost? How much is the premium? Is there a per-visit cost for seeing PPO doctors or other types of co-payments for services?
  • What is the difference in cost between using doctors in the PPO network and those outside it?
  • What is the deductible and coinsurance rate for care outside of the PPO? Is there a limit to the maximum paid out of pocket?