Managed Care / Preferred Provider Organizations (PPOs)

PPO is the most flexible and most expensive type of managed care plan. With a PPO you don’t have to select a primary care physician, you can go directly to a specialist, no referral is needed. You can choose to receive health care services within the network of preferred providers – doctors and hospitals in the organization, or you can go to a doctor outside of the network. If you choose health care outside of the network, you’ll have to take care of all the paperwork involved: filling out forms, taking care of bills and receipts.

In addition to the fixed monthly premium, with a PPO you have to pay several other fees. With preferred providers there’s usually a small co-payment for each visit. With non-network providers, you’ll have to meet a deductible before the insurer starts paying. After the deductible is met you’ll have to cover a percentage of the cost and, if you are using more expensive services, the difference between your health care provider’s bill and what your PPO insurer considers to be “reasonable and customary” for the service.

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