Health insurance is a contract with an insurance company in which you pay a monthly fee of some kind, and the insurance company helps you smooth out medical expenses when and if necessary. By buying health insurance, you protect yourself from unexpectedly high costs in case you need medical care. What is ppo health insurance? Let’s try to understand the features of health insurance and talk about PPO.
Features of PPO health insurance: everything you need to know
PPO insurance means that you can be treated at both in-network and out-of-network clinics. In-network, you’ll get a better deal. If you go to out-of-network doctors, you’ll probably have to pay extra fees and the terms will be less favorable to you. PPOs usually don’t require you to get a referral from your GP to a specialist. PPOs usually have a much wider network of doctors. This type of insurance is usually more expensive than the others.
How does it work
Let’s say you have health insurance. And you need to see a doctor.
In most cases, the procedure will be this.
- You have a membership card the size of a bank card with the insurance company, your insurance number, the names of all the people “covered,” the type of insurance, and the start and end dates.
- You go to the doctor’s office and the front desk asks you if you have insurance. You hold out your card, they take the information and give it back to you.
- While you are there, they have time to check your insurance and find out all the conditions – Deductible, Co-Pay, and so on.
- After the visit, or at the end of treatment, all documentation is sent to the insurance company. The insurance company pays the clinic what is owed and sends you by mail the so-called EOB, Explanation of Benefits.
- If you end up owing more money to the clinic, you get a bill in the mail from the clinic for the missing amount.
Coverage for Services and Drugs
Every insurance plan has a very long and detailed list of services, procedures, and drugs that are covered. And what they don’t cover. Some insurance plans include a dental and ophthalmology plan, but most plans do not. The insurance plan usually comes with a hundreds of pages long book (Summary of Benefits) listing everything the plan covers, and you can usually look on the insurance company’s website for a database of covered drugs. There is a chance your drug might not be covered by the plan (if so, you can try to find a covered version of it).