Preferred Provider Organizations

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November 11, 2012 by astancilwomack

As I mentioned in yesterday’s post, I am going to give an over view of another insurance type, Preferred Provider Organizations also known as PPOs. PPOs are basically the exact opposite of HMOs. The PPOs allow the patient more freedom by choosing their physicians. Patients with PPOs do not have to have a primary care physician, or a referral to see other providers. This allows patients more freedom, but also more responsiblity. Unlike HMOs patients have to ability to see any provider of their choosing, but it does not come without cost. If a patient chooses to see a provider outside of the networks preferred providers, then they are usually subject to more out-of-pocket costs.

Unlike HMOs where the patient is subject to a pre-set co-payment, PPOs are subject to a percentage of the service charges. The patient is also usually required to meet a deductible before the insurance coverage kicks in. PPOs are better for providers when they are in-network because their contracted fees are usually higher than HMOs. When a patient sees a provider out-of-network the provider can actually get paid more because it is not at a discounted rate, but it is at the patient’s expense.

Have you had experience with both HMOs and PPOs? If so, did you prefer the freedom of PPOs or the financial benefit of HMOs better? Feel free to comment about your experiences.



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Mandy Stancil-Womack

My name is Mandy Stancil-Womack. I am interested in pursuing a career in medical management. I am learning as much as I can in order to start my career. This page allows me to explore different aspects of medical administration.

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