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How Does a PPO Plan Work?

Health insurance market is one of the fastest growing on a global level with new companies and possibilities multiplying on a daily basis. There are many different opportunities for customers, especially expats who should be very careful when choosing a proper health plan for themselves. Expats should do a thorough research and get to know what is the market offering so they can pick an insurance that covers all or at least most of their needs.
What is a PPO Plan?
PPO Plans have become one of the most popular health insurance plans in both Individual and Family markets. The main reason for their expanding popularity is the relative freedom that expats have when choosing doctors and hospitals they want to visit. When living in a foreign country this freedom of choice can be a crucial step in your recovery process. PPO is, in fact, an abbreviation for "preferred provider organization" and the reason for that name is because they have lists of health care providers they prefer whose services you can use. But this does not necessarily mean you cannot pick some other doctor or health facility. On the contrary, you can choose services from the organizations out of the PPO network, and they are still covered, but they will cost you more. Also, in most cases PPO plans will include the prescription drugs too but this is something you should still ask on the spot when negotiating the terms. There is also one more huge benefit of these plans, and that is you don't need to acquire a referral to see a specialist in PPO Plans.
Are There Any Limits?
Well, PPOs are a type of managed care health insurance plan like their distant cousins, HMOs, so they too have rules about how you must get your health care. If you don't follow these rules, you will have to face one of these two possibilities. Namely, either they won't pay the cover of your care, or you will have to spend a greater portion of it from your pocket. PPO plans are limiting their services to only things that are medically necessary or that go under the preventive care. They will also negotiate discounts for you from the providers you’re allowed to receive the health care, so they are limiting you who or where you can get these services. 
Cost-Sharing Model
PPO health plans are an excellent way to preserve your health plus to save some money. This is especially important to expatriates because it is not easy to buy expensive health plans and pay enormous amounts for medical treatments. What is more, PPOs are easy to understand. The primary model of PPO plans relies on cost-sharing. Namely, the cost of your doctors’ visits, medical examinations, and possible treatments is shared between you and your insurer. But, one of the most crucial advantages of the PPO plans is that you have the opportunity to choose your specialists and doctors, no matter in which medical facility they work. However, the catch is an In-network and out-of-network system. Such a system will be further explained. So for all those uninformed: PPO plans share your medical costs in the forms of deductibles, copayments or coinsurance. In this way, your insurer wants to limit your visits to medical facilities only to those you need. So, once you visit a doctor and share the cost of your visit, you will limit your visits and avoid unnecessary visitations. But there is one advantage when it comes to preventive services. Namely, Affordable Care Act forbids PPO plans to require cost-sharing for preventive services.
In-network And Out-of-network Services
Every PPO plan has some in-network services. You must know that in-network service has all kinds of medical specialists, facilities, and examinations that can be needed. You should be aware that in-network services are paid less than out-of-network services. For example, you got sick, and you want to visit a doctor. If you visit the one that is in-network of your PPO plan, then your costs are much lower, and they take up a small percentage. But if you visit the out-of-network doctor, then you will pay at least half of the cost. So, if the examination requires $500, you will be asked to pay $250. However, this is just one more advantage of the PPO plan because other policies do not cover any costs if you visit out-of-network specialists.
Pre-Authorized Services
Preferred Provider Organization Plans want to make sure they pay only those medical treatments that were needed. So, before doing any medical treatment, you should get a pre-authorization of your insurer. On the contrary, a PPO will not pay for your treatments, and you will have to pay the full cost. Therefore, you should be careful. Consult your insurer in any case and inform yourself on what you have to pay and what not.
Therefore, before you choose an insurance plan, you should think about what you need. If you have just moved to another country, think about a PPO plan. It allows you to visit any doctor you like, to hear more opinions, plus to share the costs of your visits.
August 18, 2015 00:00:00


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