Preferred Provider Organization (PPO)
People enroll in a PPO through an employer, who either covers the entire premium or a portion of it, with the remaining cost deducted from the participating employee’s payroll.
A PPO is a managed care health plan that gives its members multiple choices in health care and health care providers. You or your employer pay a monthly or quarterly premium for coverage of a broad range of medical services. Like an HMO, a PPO may charge a copayment for each office visit and there is usually no paperwork to complete. The network of physicians is often much larger than an HMO.
The PPO does not require the use of a primary care physician (PCP) or a referral to see a specialist. While the PPO is more flexible with their rules than with an HMO, members may pay higher premiums to be part of the PPO and also make higher out-of-pocket payments to their doctor at an office visit. You may be able to keep your out-of-pocket spending lower by using one of the PPO’s network providers.
Although plan members can generally receive care from providers outside of the network, they will likely pay more for their care. If you don’t want to switch doctors, a PPO may allow you this flexibility.
A PPO offers more flexibility, but an HMO is often better than a PPO in terms of cost. HMOs, or health maintenance organizations, are coordinated through a single doctor, whereas PPOs, or preferred provider organizations, allow patients to visit any health care professional.
Be sure to review the Summary Plan Description (SPD), which is the part of the PPO policy that outlines the different benefits provided by your employer or insurance company.
Bleeding Disorder Specifics
- Be sure your HTC and all other specialists are in your PPO network.
- Some insurance policies require a prior authorization for factor or medications. This can take one to seven days to obtain. Order early to insure your factor will be to you on time.