PPO Medical Plan Definition

Anyone who is shopping for or who has health insurance should be aware of the PPO medical plan definition. A Preferred Provider Organization, also referred to as a PPO, is a type of medical plan that uses a specific network of healthcare providers who participate in the insurance and whose services will be covered by the medical plan.

For those with a PPO, it is especially important to know and understand the PPO medical plan definition so you will be aware of what your coverage- and its limitations- is.

• If you have a PPO medical plan, you're expected to get your health services from one of the providers within the preferred provider network.
• You're free to go out of the network and see any provider you like, but it is not guaranteed that your insurance will pay for your care with a non-network provider.
• PPO health care providers work with insurance companies in order to reach agreements about providing various services at pre-negotiated price points, thus making the process of insurance claims and payments simpler for both of them. This means that all negotiation is done before you come along, and explains why you are encouraged to use these providers.
• If you choose to go to an out-of-network health care provider, you may certainly submit the visit and cost to your insurance company, but they are under no obligation to pay it. There is the possibility that they may be willing to negotiate payment with the provider, but the provider also has to be willing to work with the insurance company, and this is essentially not only a financial risk for both of them, but a great deal of extra work.

Those who sign up for PPO medical plans are encouraged first to make sure the insurance plan is accepted by their preferred providers, and that any doctor, dentist, or other provider they wish to see are included within the plan's network.