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Ppo vs

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Submitted By dmathe21
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A Preferred Provider Organization (PPO) provides financial incentives for patients to use designated health care providers, but also provides coverage for services rendered by health care providers who are not part of the PPO network. Financial incentives for individuals to use preferred providers include lower copayments or coinsurance and limits on out-of-pocket costs when using in-network providers.

Point-of-Service (POS) plans may be offered by managed care organizations or traditional indemnity insurers. POS plans provide financial incentives for using network providers (for example, a fixed copayment instead of a 20 or 30 percent coinsurance rate). However, a POS option allows you to go outside the network and see any doctor you choose without a referral. If you do utilize non-network providers, expect to pay a substantial portion of the bill yourself. The POS plan will pay its share based on discounted fees it negotiates with doctors and will take into consideration deductibles and coinsurance before it determines the payment.

What Does This Mean to You?

Consider a PPO if:HMO
You want to keep your health care options open.
You want more freedom of provider choice.
You want to "self-refer" to specialists.
You don't mind having larger out-of-pocket expenses and/or employee contributions.
Your doctor is not a member of the network, and you don't think you would be happy with another type of plan, such as an HMO.

Consider a POS Plan if:
You like the features of an HMO but also want an "escape." For example, you want to have the ability to visit a renowned medical facility, for example, if you felt you weren't receiving quality care from your Primary Care Physician.
You travel outside the plan's service area or have dependents living out of state.
Your current doctor and specialist are members of the network.
You want to keep your costs for in-network care lower.

Source:
https://pcms.plansource.com/entities/18315/pub_nodes/16064

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