The Benefits of PPO Networks You Need to Know
- June 1, 2023
- Ask Betty!
Welcome to this week‘s episode of “Ask Betty!”, Episode 151, featuring PPO NETWORKS. This week we‘re answering a question from GA_stat about why everyone seems to want a PPO Network. In order to answer this question, it‘s important to look at what a PPO Network is and the benefits it offers.
Q from YOU to Ninja HQ
“Why does everyone seem to want PPO Networks?”
PPO Networks
That is correct GA_stat; many people find these PPO networks very attractive. A PPO, or Preferred Provider Organization, is a type of health insurance plan that offers members a network of “preferred” healthcare providers. Members of a PPO plan have the flexibility to choose any providers in the preferred network, without needing referrals or getting permission from the insurance company.
PPO Networks - Flexibility & Easy Access
This type of plan offers two main benefits: flexibility and access to a wide selection of healthcare professionals. Most healthcare providers, including doctors, specialists, labs, imaging centers, physical therapists, and hospitals, are part of the PPO network. This means members can access care from any of these providers quickly and easily.
Another advantage of a PPO is that you don’t need to file claims or wait for coverage decisions from your insurance company. Your preferred provider is often able to handle the claims and paperwork associated with the service for you.
PPO Networks: Coverage Limitations & Emergencies
PPO Networks can be Statewide OR Nationwide. They are also available in every State’s Private Market BUT only some States offer them on their Public ACA Marketplace plans.
As of January 2023 a new law was enacted that declares now insurance companies CANNOT charge out–of–network fees for anything coded an “emergency on ANY type of Network.
This means, if you have an HMO and experience a broken ankle, heart attack, etc while out-of-State, you’re coverage would work EXACTLY the same as if you were at home.
PPO Networks: Out-of-Network Access BUT Expensive
For many, one of the biggest draws to a PPO is the option to go out-of-network for care. Although you’ll likely get the best coverage when using an in-network provider, a PPO may cover expenses for out-of-network care, although usually at a lower rate than if the care were provided by a in-network provider.
However, the downside to PPO plans is that they tend to be more expensive than other health insurance plans. This is because the insurance company is responsible for more out-of-pocket costs and is looking to recover those costs by charging higher premiums. Additionally, PPO plans usually have high deductibles and offer a lower level of benefits than other plans.
PPO Networks in Summary
In summary, PPO networks have many advantages for those who need flexibility and access to a wide selection of healthcare professionals. But they also tend to be more expensive than other insurance plans and may not always provide the best coverage. It is important to evaluate your specific needs and budget before deciding if a PPO is right for you.
Ask Betty!
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The Benefits of PPO Networks You Need to Know
- June 1, 2023
- Ask Betty!
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Get your bi-weekly dose of “Ask Betty!” series. This is an activity that YOU can participate in, and if YOUR question is used in an Episode, we’ll email you a $25 Amazon gift card! Good luck.
PM your insurance question to Ninja Betty via our Facebook Business page (here).
Stay in the Ninja News Loop!
Subscribe to our monthly newsletter & receive all our free resources once a month in your Inbox.
Check Us Out!
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