PPO Health Plans in Georgia
A PPO is a comprehensive insurance program that allows flexibility in a choice of deductibles and providers.
In a PPO plan, the insured chooses a primary care physician from a list of doctors that have agreed to perform services at reduced prices. The primary physician may recommend a specialist, but the insured does not have to wait for a referral in order to see that specialist. Patients who seek care from providers not on the list are expected to pay a larger percentage of the cost for that treatment.
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Advantages of a Preferred Provider Organization (PPO) Health Plan
- Out-of-pocket costs are tied to the choice of deductible, the amount of co-pay, and the percentage of co-insurance on the plan
- Preventive care may be covered
- Using the preferred provider list can substantially lower costs
- After the deductible is met, the plan pays a set percentage of costs
Disadvantages of a Preferred Provider Organization (PPO) Health Plan
- Out-of-pocket costs are greater than for an HMO.
- You must meet your deductible before the plan begins to pay for coverage
- Claims must be filed for out-of-network and some in-network services
- There is a small co-pay at each doctor visit
- Pre-certification is required of all hospitalizations and most elective treatments
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Preferred Provider Organization (PPO) Health Plan Details
The focus of a PPO is to cut costs through using a select group of providers that will give deep discounts to the insured. The insured is expected to use providers within the list. The PPO monitors the number of visits and the care received to make sure that an optimal number of visits take place. The PPO also decides which treatments are permissible under the plan. Most PPOs offer some preventive care coverage that will be paid for before the deductible is met.
This type of plan has the most flexibility. Choosing a high deductible lowers the monthly premium costs for those who do not visit the doctor often. Choosing a lower deductible means a higher premium but lower initial costs for those who need care more often. The plan usually pays a percentage of care costs after the deductible is met (for instance, 80 percent of all costs), while the patient pays the remaining costs.
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