A preferred provider organization, more popularly known as a “PPO,” is a health insurance group that establishes a network of care through participating local providers. The medial professionals who participate are guaranteed a pipeline of potential patients, while members enjoy a discount on premiums and deductibles.

PPO insurance plans are typically compared to health maintenance organization (HMO) plans when people are considering which coverage options work best for them. Both offer savings to consumers through a network of local providers, but there are many key differences that make a PPO unique.

Studying the basics of PPOs will better prepare you for deciding between different types of insurance plans.

Why Might I Want a PPO?

If one person might prefer an HMO for the sake of security, another might select a PPO for the sake of flexibility. In-network coverage under an HMO plan is guaranteed, but customers have considerably limited options if they need medical help out of network, such as if an emergency occurs while they are on vacation.

Key benefits of insurance through a PPO include:

  • Freedom of Choice – PPO customers won’t have to stress over whether a provider is in their health care network. They are free to get care from any doctor’s office or hospital, depending on the situation. PPO customers may need to cover an out-of-pocket cost, but for individuals who prefer flexible health care options, this is a small price to pay.
  • No Need for Referrals – HMO customers have their health care managed and monitored by a single primary care provider (PCP). These physicians are also in charge of determining when a patient needs a specialist or unique procedures. For this reason, patients who would prefer to maintain complete control over their health care decisions choose PPO plans over HMO options.
  • Partial Out-of-Network Coverage – Coverage is not an all-or-nothing issue when it comes to PPO plans. In many cases, PPO plans offer some coverage for patients seeking care out-of-network. The amount of care provided will vary from company to company, but this option represents a smart compromise between the flexibility of a PPO and the cost savings attributed to an HMO.

What Are The Limitations of a PPO?

There are some cases where a PPO is the wrong way to go. This may be related to cost savings or coverage options, but it’s clear that the PPO is not the right fit for every insurance customer. Reviewing the limitations of a PPO can make it clear why.

Potential disadvantages of acquiring an insurance plan through a PPO include:

  • Less Predictable Costs – HMO customers are limited to working with certain health providers, but as a result, their medical costs are far more stable. Individuals with a PPO plan may find themselves seeking care in and out of their network, making it difficult to plan around and afford health care services.
  • Potential for Disorganized Care – PPO plans do not require patients to work through a primary care specialist (PCP). Eliminating the need for a PCP helps make PPO plans even more flexible. On the other hand, patients with a PPO plan do not get the benefit of a dedicated health professional who can deliver or orchestrate comprehensive care.
  • Additional Paperwork – Another benefit of sticking to an HMO plan is that in-network services do not require claims to be filled out before the patient can receive care. Those who select a PPO plan will have to deal with the company’s claims process if they hope to receive their full coverage. The logistics burden on patients with other types of health care coverage is considerably lower.

Enlisting Expert Help in Your Health Care Decision

Additional research will help you decide which insurance plan is the right fit for your health needs. You can also rely on the expertise of Addiction Treatment Services if you have further questions about each type of health care plan.

Our mission is to help those struggling with addiction and their families understand their next step for getting treatment. Often times, this involves coordinating with insurance companies to make sure you get the coverage.

Get in touch with us if you have more questions about which types of insurance are the best fit for supporting recovery from addiction – whether it’s for yourself or a loved one.