How to Choose a PPO

The type of health insurance plan known as a PPO, or preferred provider organization, comes with some specific setups in order to help members see a variety of doctors without incurring extra costs. Although patients can get special rates for visiting any doctors that are in network, going beyond the approved network of care providers will often result in much larger bills. For those who want to choose a PPO, some basic steps will help in the process of making good decisions on these kinds of health-care plans.

Steps

    1
    Find a PPO with a good network. Because the network is so important from a cost perspective, find a PPO that has doctors near you, and doctors that you will probably want to go to. Arranging the network to suit your needs will save you a lot of money with this kind of health insurance plan.
    2
    Get coverage details on the PPO plan. Send for additional insurance information on paper and analyze it to see if a specific PPO plan is likely to meet your needs without costing you too much money.
        See what is covered. Look for specific coverage through co-pays and coinsurance for each specific kind of care, including surgery, outpatient visits and regular doctor office visits.
        Look for exclusions. Exclusions are certain kinds of care that are specifically not covered under a particular policy. Peruse your policy to see what is excluded and whether you may need these excluded services.
        Look carefully for annual or lifetime maximums. One of the tricky items in some of the less useful major medical policies is in the form of a maximum. Look carefully, because this maximum is the maximum amount that the company will pay out on your policy. Policies with low annual or lifetime maximum amounts are virtually useless, since the major purpose of health insurance is to cover the extremely high costs that rack up quickly for just about any injury or illness. A good plan should have at least a $1 million annual maximum and no lifetime maximum benefit. Most conventional PPO policies don't have a maximum benefit, but some do, and those are worth steering clear of.
        Look at additional coverage for extra things like prescription drugs, maternity and more.
    3
    Get the health insurance company's policy on referrals. Within a PPO health care plan, many patients need a referral from a family doctor in order to see a specialist. Referrals can determine whether or not the patient is billed for the full out-of-pocket cost. Check out how your company handles referrals and think about this before signing the document.
    4
    Look at costs from a holistic point of view. One of the best ways to handle a PPO is to know about what it will cost you to visit doctors in network, as opposed out of network, and how you will handle premiums, co-pays and other costs.
        Evaluate your PPO along with an HSA strategy. An HSA, or health savings account, is another way to save money on medical care. See if your PPO complements this government-backed saving strategy.