PPO Plans in Michigan
A PPO is an inclusive insurance program that allows flexibility in selecting co-pays, deductibles and providers. In a PPO plan, the patient chooses a primary care physician from a list of doctors that have agreed to perform services at reduced prices. These doctors are preferred or "in network." The primary physician may recommend a specialist, but the patient does not have to wait for a referral in order to see that specialist. Insured clients who seek care from providers not on the list are expected to pay a larger percentage of the cost for that "out-of-network" treatment.
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Advantages of a Preferred Provider Organization:
- Out-of-pocket costs are tied to the choice of deductible, the size of the co-pay, and the percentage of co-insurance on the plan.
- Preventive care is usually covered
- Using the “in-network” or preferred provider list significantly lowers costs.
- After the deductible is met, the plan pays a set percentage of costs.
- There is a small co-pay at each visit, the percentage of the fee remaining after the PPO pays its share.
Disadvantages of a Preferred Provider Organization:
- Out-of-pocket expenditures are greater than for an HMO.
- Except for some preventive care, the plan only begins to pay for coverage after you have met your deductible
- Claims may need to be filed for out-of-network services
- Pre-certification is required of all hospitalizations and most elective treatments
Preferred Provider Organization (PPO) Plan Details
The focus of this type of insurance is to cut costs through using a network or 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 governing board also decides which treatments are eligible to be covered under the plan.
This type of plan has the most flexibility. Choosing a high deductible lowers the monthly premium costs for those who seldom visit the doctor. Choosing a lower deductible requires 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 amount.
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