A Preferred Provider Organization, or a PPO, is health care organized by a particular insurance company. Medical professionals, hospitals, and clinics are contracted by the insurance company to work with the PPO system. The PPO decides the managed medical care guidelines and the fee schedule and the medical professionals, hospitals, and clinics that are contracted by the PPO agree to these terms.
A PPO is similar to a health maintenance organization (HMO) in that it offers a network of health care professionals available to the insured person; however, a PPO is more flexible than an HMO in that a PPO also offers the option of seeing an out-of-network health care professional. Many times people would rather visit their family doctor, or a doctor that is highly recommended, than a doctor in the PPO network with whom they may not be familiar. Yet, PPO networks usually represent a high number of medical professionals, doctors, and clinics over a large geographic area, so finding an agreeable doctor might not be that difficult.
The insurance offered by a PPO usually covers a high percentage of the cost to see a health care professional in the PPO network, and the insured person will pay a co-payment at the time of the doctor, hospital, or clinic visit. Fees for out-of-network health care professionals are often higher than fees for seeing a health care professional in the PPO network. PPOs want to encourage the insured person to visit a doctor within the network, but it is obviously not required. PPOs also require the insured person to pay a yearly out-of-pocket fee before medical bills will be covered.
Other advantages to a PPO are the fact that its premium is less expensive than that of an individual health insurance plan and the fact that PPO networks usually have a plan that will offer prescription drugs at much lower costs. A PPO will also cover more medical services than an individual health insurance plan.