Advantages and Disadvantages of PPO's
California PPO (Preferred Provider Organization)
A PPO is a group of health care professionals and/or facilities who agree upon accepted fees and health care practices. As a member, you can go to any physician or health care professional in the PPO, and pay the same low fixed copayment. You may also choose to see an out-of-network provider, pay that provider’s fees, and file for partial reimbursement from your health plan.
Advantages:
- You can keep your own doctor or choose to see any medical provider within the network or outside of it. It will cost less to see a network provider.
- Yearly limits on your total out-of-pocket expenses (copayments, coinsurance, and deductibles) are set; for example, your out-of-pocket cost for network providers might be capped at $1,200 and for non-network providers at $2,000.
- You are normally covered at in-network rates for out-of-network emergency services.
Disadvantages:
- Although you may see non-network providers, the cost is greater.
- Normally, out-of-network, you pay for services and then file for reimbursement.
- Your copayments and coinsurance may be higher than for an HMO, and you may have deductibles.
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