Benefits Of PPO Insurance: Comprehensive Guide For You

PPO Insurance

Are you currently surveying the vast medical insurance offerings currently available, trying to decide which is the best fit for your current situation and health care needs? Perhaps this is the first time you have had the choice to select your own insurance plan and need to know the basics of the best options available.

Preferred Provider Organizations, known as PPO insurance plans, are a very popular option for that are commonly chosen for their flexible benefits and network latitude when it comes to preferred providers. If you are curious about how PPO plans work and would like to know more, then this comprehensive guide is for you.

What Is PPO Insurance?

General Overview

PPO insurance plans stand as some of the most cost-effective options on the market currently. These insurance carriers contract with certain hospitals, doctors, and other healthcare entities.

This provides the option for patients to receive any necessary treatment at a greatly reduced rate. In short, these insurance plans allow you to receive treatment from any type of medical provider within the carrier’s network at a considerable discount.

Key Characteristics

One of the primary aspects of PPO insurance plans that set them apart from similar offerings is the fact that members are authorized to receive treatment from any hospital, physician, or other health care provider without a referral from a primary care doctor. This means that you can go to your primary care physician as normal, but have options if you would like to see a different provider for a specific issue you may be dealing with. If your primary care physician has no interest in referring you, you still have the option to seek out another opinion or doctor of your own accord.

PPO insurance plans are also uniquely characterized by their flexible network allowances for insured members. If you wish to select a doctor that is not within your specific network, you have the option to do so. These treatments will not be fully covered, but you can still receive partial compensation. It is always a good idea to check with the particular PPO carrier you are considering to review their exact terms and conditions.

What Differentiates PPO Insurance?

No Set Treatment Parameters

As a follow up to the discussion of network flexibility, it is important to note what factors differentiate PPO insurance from its competitor plans. It is a huge advantage to be able to choose who you wish to be treated by and where you want to go to receive treatment from.

The factor that separates the way PPO works apart from other alternatives in the market is the fact that you will be required to pay a deductible for these types of out-of-network visits. This is the tradeoff for experiencing such a degree of network provider flexibility. You will still receive a partial payout even for treatment received out of the network, but these funds will not be released until you put forth a set sum to reduce the invoice amount. Deductibles for PPO insurance plans do vary based on treatment amount, provider, and carrier. They can range anywhere from hundreds to thousands of dollars.

Again, the ability to choose your own providers even if they are not in network and still receive a partial payout for treatment is a huge plus. However, it does come with some strict rules set in place to allow this kind of flexibility.

Split Costs

Along the same lines as the deductible requirement, there is another distinct element to PPO insurance plans. In the sense that they still allow you to split the costs for treatment rendered out of your carrier network, member responsibility often comes in it at a much lower portion of the overall rates.

While some may consider it a disadvantage to owe beyond the deductible, PPO insurance is unique in the fact that it allows a cost split for services received beyond network limitations. Unlike some insurance plans that will penalize you for any providers seen that are not in your specific network, PPO carriers will usually pay anywhere from 70 to 90 percent of the accumulated costs.

This means that members are responsible for their deductible, and the remaining portion of the bill. Be that as it may, the amount which the PPO insurance plan pays takes an extensive chunk out of what could otherwise be an exorbitant payday.

The Many Benefits

Adaptable Plan

The most widely lauded benefit of PPO insurance plans is, of course, their unique adaptability to fit a wide variety of patient needs and preferences. Unlike many insurance plans which hinder the flexibility of your care, despite the circumstances of your state of health and particular needs, PPO plans let you seek treatment from any physician or medical provider without obtaining permission from your primary care physician.

It is not even necessary to have a chosen primary care doctor, which allows you to adapt a course of action based on your specific medical requirements. This means that if you want to see a specialist, you can make your own appointments and get the treatment you need without waiting for a referral order to come in.

In the time it would usually take for the referral request to come through, you can set your doctor’s visit and have any medical issue you may experience attended to in a timely fashion. This not only saves time but on costs. You do not need to overextend yourself financially to get the care you require. Rather, you can choose what facility you want to go to and see the right doctor without delay.

Network Flexibilities

Harkening back to the topic of network flexibility when it comes to PPO plans, you may also choose to stay within the list of providers afforded to you through your carrier. You need not feel limited by the providers within your network. In fact, if you choose to stay within these parameters, you will still have a much greater list to work with than some other insurance carriers might offer. PPO networks tend to be far more extensive than those of other insurance plans.

When looking at the network available to you through a particular PPO insurance carrier, be sure to inquire about that company’s process for choosing its contracted providers. Make sure they perform the necessary background checks and search for any malpractice cases that might have occurred. There are a great many excellent PPO insurance companies out there that will allow you great flexibility with quality care, but it is always a good idea to ask plenty of questions and stay informed.

Make Your Own Health Care Decisions

At the end of the day, the chief advantage to PPO insurance is the fact that it allows you to make your own personal health care decisions about the kind of treatment you want to have and who you can receive it from. The ability to see doctors in your network without obtaining a referral and the option to see some providers out of your network for partial coverage is unique.

You are not limited to and bound by the decision of your primary care physician. You do not need to expend the time, effort, and money to choose one or seek out a doctor that better meets your needs. Rather, you can go ahead and see a specialist if you require one, of your own accord. PPO insurance plans cut down the red tape of usual referrals and appointments considerably, putting the reigns of control back in your hands.


There is much to consider when looking into PPO insurance, but the advantages, in many cases, far outweigh any inconveniences that might result. The ability to obtain the care you need without a referral, to choose from a wide network list of providers, and go outside of them if you deem it necessary, can offer you unequaled freedom when it comes to making your own health care decisions.

You will need to examine your own personal healthcare situation, to see if the potential of higher deductibles and split insurance costs for seeking treatment from providers out of your network will break the bank. Alternatively, these tradeoffs might be completely worth it to you. It often depends on the actual carrier you go with, so be sure to ask any questions you might have and pay careful heed to the relevant terms and conditions.

If you find that you will be required to pay for visits out-of-network in their entirety, you will need to weight the necessity and value of the treatment against your personal set of circumstances. Bear in mind, that even adhering to providers in your network still allows you a great deal of latitude to receive varied health care at a greatly reduced cost due to the contracted providers.

Some PPO insurance policies only allow partially covered care received out of the network in certain health situations. A number set a limit on the maximum payout they will make while others are more flexible in this area. Be sure to choose a PPO insurance policy that allows a maximum payment for care of at least $1 million. Provided the referral standards and benefits for treatment both inside and outside of your network are sufficient, a PPO insurance plan is the ideal choice if you are looking to exert greater authority over your own standard of care and personal health decisions.

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