What does ppo stand for in health care

Last updated August 24th, Reviewed by Kim Buckey. At HealthCare. We adhere to strict editorial standards. This post may contain links to lead generation forms, which is how we make money. However, this will not influence our writing. The content of this page is accurate as of the posting or update date. Read more. What is a PPO? With a PPO, you can choose to see any provider you want, however, you will pay less when you see an in-network provider.

And, in most cases, your in-network provider will file claims with your insurance company for you. In general, monthly premiums, copays and coinsurance for a PPO are more expensive than those for other types of plans. But if you can afford it, the flexibility of being able to use a wider network of doctors and hospitals often makes the higher cost worthwhile.

Another plus — if the network does not have a participating provider who can provide medically necessary services, the plan may authorize you to see an out-of-network doctor, and cover the services at the in-network rate. PPOs typically cover more services than other types of plans. If you are looking for the least expensive health insurance option, you might want to avoid a PPO. The one exception — when the PPO is also a high-deductible plan, which frequently has lower monthly premiums, copays and coinsurance.

In general, a PPO is the most expensive type of plan. If you are shopping for coverage on the ACA exchange, remember, depending on your income and whether your employer offers you affordable coverage, you may qualify for a premium tax credit that might make the cost of a PPO more manageable.

One of the most significant issues with a PPO is whether a service provider is in-network or not. While it may be easy to determine if your regular doctor is in-network though you need to be careful because providers move in and out of networks regularly doctors providing specialized services may not be, and that could cost you. For example, you have surgery at a hospital within your network. According to a study for the consumer group Families USA, 44 percent of participants said they or a member of their family received a surprise medical bill from an out-of-network provider.

That number is up from , when a Stanford University study showed about 26 percent of people had received an out-of-network bill. To help avoid such surprise billing, carefully read your plan benefits, and check with your doctor and hospital before any procedure to request that all doctors who give you care are in-network. You may still receive care from an out-of-network provider but at least you might be warned such a bill is coming. Sometimes indemnity health insurance plans cost more than HMOs and PPOs , but the payoff is the flexibility of choices.

Indemnity plans allow you to direct your own health care and visit almost any doctor or hospital you like. The insurance company then pays a set portion of your total charges.

Indemnity plans are also referred to as "fee-for-service" plans. Hospital indemnity insurance is not traditional health insurance. Note: you may receive a medical card because some hospital indemnity insurance plans can act as primary health insurance. In your case, however, you won't need that card since you have primary health insurance. With indemnity plans, the insurance company pays a pre-determined percentage of the reasonable and customary charges for a given service, and the insured pays the rest.

Who are the top 5 health insurance companies? In the United States, there are currently more than health insurance companies that offer medical coverage. What is an example of private indemnity health insurance?

What is private indemnity insurance? Private indemnity insurance is a type of medical coverage obtained through a private source, as opposed to a publicly funded program like Medicare.

An individual can purchase private indemnity insurance on his or her own or through an employer. What is indemnity with example?

Indemnity is compensation paid by one party to another to cover damages, injury or losses. An example of an indemnity would be an insurance contract, where the insurer agrees to compensate for any damages that the entity protected by the insurer experiences. So, unless you're a person who sees a lot of specialists, a PPO plan could cost you more money over the course of a year.

This information can help you if you're shopping for health insurance and want to learn how HMO and PPO plans are different. All these plans use a network of physicians, hospitals and other health care professionals to give you the highest quality care. The difference between them is the way you interact with those networks.

With an HMO plan, you pick one primary care physician. All your health care services go through that doctor. That means that you need a referral before you can see any other health care professional, except in an emergency.

Coordinating all your health care through your primary care physician means less paperwork and lower health care costs for everyone.