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What is PPO Insurance?

Insurance Option Could Save You Time, Money

Preferred Provider Organization, or PPO, insurance allows you to visit any physician or healthcare provider in your network without referral from your primary care doctor. Decide if PPO insurance is right for you and your family.

What's a Provider Network?

A provider network is made up of healthcare professionals and facilities that provide services for agreed-upon costs. Limiting the number of providers reduces paperwork, and the savings can be passed on to consumers.

What's the Advantage of PPO Insurance?

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For most people, the biggest advantage is the ability to make an appointment with a specialty care provider without having to wait for a referral. In a non-emergency, it may be weeks before getting in to see your primary care physician, then several more weeks (or even longer) to see a specialist. With a PPO, you do not need to choose a primary care physician (PCP). You have greater flexibility when it comes to selecting a provider or medical facility. For example, if you or your child gets a skin rash, you could make an appointment directly with a dermatologist.

Remember, though, that your insurance company will probably pay a higher percentage of your claim if you select an in-network provider than one outside the network. In the example above, a PPO would pay a higher percentage of the fee for an in-network dermatologist than one outside the network. It's always wise to verify coverage when making an appointment with a provider of your choice.

What is PPO MultiPlan?

MultiPlan is an independent PPO network including 4,500 acute care hospitals, 110,000 ancillary care facilities and 550,000 healthcare providers. Individuals cannot enroll in MultiPlan. The company works directly with large and mid-sized insurers, PPOs and other entities that pay health insurance claims.

What's Non-PPO Insurance?

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An alternative to PPO insurance is the HMO, or Health Maintenance Organization. It's less expensive than PPO insurance but it does not offer you the same flexibility. You choose a Primary Care Physician who will refer you to specialty providers within the network. Visits to a non-network provider are not covered by an HMO except in case of a true emergency. With some HMOs, you may have to live within a certain geographic area to be eligible for coverage.

Another alternative to PPO insurance is Exclusive Provider Organization, or EPO insurance. This combines features of the PPO and the HMO. You won't need to choose a primary care physician, and you won't need a referral to see a specialist. You must, however, choose a specialist within the network, or the insurance company will not pay the claim.

How Do I Decide What's the Best Insurance for my Family?

HMOs are best for individuals who are generally in good health. All care is coordinated through a primary care doctor, and consultation with numerous specialists is not anticipated. These plans are the most affordable but offer the least flexibility. PPOs are the most expensive plans, but offer the greatest flexibility in choosing providers. A PPO is a good choice if you or a family member require specialty care, and you want to select your own providers. EPOs limit your selection of specialists to in-network providers, which helps to contain costs.