| Many Texans shopping for individual health insurance | | | | Toll-free telephone numbero Internet website directory |
| do not understand what a Preferred Provider | | | | addresso Preferred provider directory. |
| Organization (or PPO) is all about. A PPO negotiates | | | | PPO directories contain a complete list of physicians, |
| discount arrangements with doctors, hospitals and | | | | their specialties, office locations and telephone |
| other providers who accept lower fees from the | | | | numbers. Or you may contact the network directly to |
| insurer for their services. As a result, your cost sharing | | | | find a participating provider. |
| is lower when compared to going outside your | | | | The PPO tries to keep its directory accurate and |
| network of providers. The bottom line — PPO | | | | up-to-date. However, you should verify PPO |
| providers offer health care at a reduced cost. | | | | participation with your individual healthcare provider |
| With most PPO plans, you are responsible for paying | | | | before receiving any services. If you choose an |
| an annual deductible and coinsurance, which is a | | | | out-of-network doctor, just remember — by using |
| percentage of the charges. PPO plans charge higher | | | | PPO providers, you receive care while paying less for |
| deductibles and coinsurance for out-of-network | | | | it. However, since you are still covered under the |
| providers than for network providers. In addition, very | | | | out-of-network benefit in the plan, you can use a |
| frequently PPOs calculate what they will pay based on | | | | non-PPO provider at any time. |
| what they would have paid a network provider. | | | | In order to get the favorable PPO benefits, you need |
| Therefore, you can be liable not only for the higher | | | | to verify the PPO network participation of every |
| deductible and co-insurance, but also for the difference | | | | healthcare provider, not just your primary physician. If, |
| between what the provider charges and what the | | | | for instance, your physician sends blood work to a lab, |
| insurer "allows" based on the network price. So you | | | | you need to verify that the lab is a network lab. If you |
| can save a great deal when receiving health care | | | | have surgery, which involves an anesthesiologist, the |
| through PPO providers. | | | | anesthesiologist needs to be a network doctor if you |
| In Texas, individual insurance companies must provide | | | | want discounted pricing. Likewise, the radiologist, whom |
| you with a "PPO Disclosure" which describes your | | | | you never meet, but reviews your CAT scan, also |
| PPO benefits and financial responsibilities in detail. If you | | | | needs to be a network doctor. |
| are covered under an employer or other group plan, | | | | When selecting a PPO, don't just look to see if your |
| similar information can be found in the Summary of | | | | doctor is included in the network, but also consider the |
| Benefits. | | | | range of doctors and other providers available in both |
| An important benefit of PPOs is the ability to make | | | | your area and beyond. You never know when you will |
| self-referrals. In essence, plan members can refer | | | | need specialist care or medical care out of town. |
| themselves to doctors of their choice, including | | | | Some PPOs have a limited number of doctors and |
| specialists, inside and outside the network. However, | | | | providers in your area but will not have doctors and |
| as previously mentioned, plan members may incur | | | | providers outside of your area or state. PPOs will |
| additional charges for using out-of-network providers. | | | | generally cover bona fide medical emergencies outside |
| With a PPO, you're being served by community-based | | | | of your home area as "in network" even if you use a |
| physicians and hospitals. You have the choice of using | | | | non-network provider, but this does not help if you are |
| either a PPO provider or a non-PPO provider every | | | | out of area and need non-emergency care. |
| time you seek medical services. | | | | When you visit a PPO provider, you will be asked to |
| When you look for a PPO physician, you'll be provided, | | | | present your medical identification card. PPO providers |
| at no cost to you, one or more of the following | | | | will generally submit your claim to your insurance |
| methods of access to the PPO you have selected:o | | | | company on your behalf. |