PPO

PPO stands for Preferred Provider Organization. Unlike an HMO, members of a PPO can go outside of the organization to get their health care needs met. This means that if you become a member of a PPO and your long-time family physician is not a member of the PPO, you can still choose to see your family physician.

One of the differences between a PPO and an HMO is that ff you are a member of an HMO you cannot see a doctor that is outside of the organization.

However, while it is true that you can see a doctor who is not a member of your PPO, you need to be aware that it will cost you more out of pocket than if you see doctors who are members of the PPO. So while you have a greater choice in the doctors you see as a member of a PPO as opposed to being a member of an HMO, the bottom line is that it will cost more to see an unaffiliated doctor even if you choose to be a member of a PPO.

Here’s how it works when you are a member of a PPO. If you choose a doctor within your PPO network of physicians then, in addition to your monthly premium, you will be required to make a small co-payment each time you see your doctor, just as you would if you were a member of an HMO. Typically co-payments are in the range of $5 to $25 per visit, depending on your monthly premium.

If you see a doctor outside of your PPO network then you will be required to pay the doctor out of your own funds and then submit a bill to your PPO. Your PPO will reimburse you for a portion of the bill, typically 80 percent of what your PPO would have paid for the same service from one of their network physicians.

If your non-PPO doctor charges more than the contracted fee that a PPO doctor would have charged (which is likely) then you can expect to pay more than 20 percent of your non-network doctor’s bill out of your own pocket.

Still, for many people it is worth the extra cost to be able to remain with a physician that they have known for years and whom they trust.

When making the decision of whether to join a PPO or an HMO check first to see if your family physician is a member of either organization. If not, then you must weigh out for yourself the value to you of continuing to see your physician as opposed to the money would save by seeing an HMO or PPO-approved doctor.