GENERAL INFORMATION
PPO insurances are as varied as there are insurances who offer them. In general, the PPO insurance has a network of providers and the patient will receive a discount for staying within their network of providers. They do not have to have a referral for services however precertification is generally still required of all Inpatient stays.
COVERAGES AND COST TO PATIENTS
The patients are able to go to any physician or medical facility that participates within their network. The will owe deductibles, coinsurance and sometimes copays. Some of PPOs has a cap on the yearly expenses that the patient must pay. If the patient goes to a medical facility or provider that is not within their network the services may still be covered however at a rate that does not include a discount. Thus, the patient will owe more in coinsurance and if denied for payment then they will be liable for the entire bill. These plans are very popular in that the patient can choose where they want to go for medical services without as many restrictions that the HMO carriers impose.
These insurances have a variety of different products to offer their clients and have evolved to include plans that seem like hybrids of the HMO/PPOs. That is they have elements of both types of insurances with strict or semi-strict networks, copays and coinsurance and out-of-network benefits at a higher cost to the patient.