An Important Guide for the PPO Plan Patient
If you, or a loved one, is suffering from pain, injury or weakness and you’re wanting to get some help from a physical or occupational therapist. You have the option of going to either an in-network or out-of-network provider.
In this video, you will learn how to navigate through this process so you can make an informed decision and focus on getting better, not insurance headaches.
If you have a PPO plan, its important to understand that you have freedom of choice. You can choose the provider you wish to go to and most likely you will have benefits that can be applied towards your care.
Here are some things most people don’t know:
1) Most PPO plans have a deductible whether you choose an in-network or out-of-network provider.
“What is a “deductible?”
In simple terms, its an amount that must be paid by you BEFORE your health plan activates and turns on. Typically this amount ranges anywhere from as low as $200 to as high as $10k depending on your plan. (Some plans may fall out of these ranges).
Its important to note, that your deductible may be different for in network vs out of network providers.
What is an Out-of-Network Provider?
This a provider (typically a medical professional) who has chosen not to participate with a particular health plan. They would be considered an Out-of-Network Provider (OON).
With a PPO plan, you have the freedom to choose OON providers. And sometimes they may be the better choice depending on the nature of your condition.
Why does a provider choose not to participate with an insurance plan?
There are many reasons why a provider might choose not to participate with a health plan. But one of the common reasons are due to the decreased reimbursement rate the insurance imposes in order for that provider to join the network. Often times the rate is too low for the standard of care the provider wishes to provide.
Typically, the level of quality provided by OON provider is higher than the in-network provider. This is largely due to the OON provider’s avoidance of time-consuming insurance hassles and steep discounts.
If you choose to go to an OON provider make sure you understand these important steps.
1) Find out what ur deduct, and/or co-pay might be. Its best to be informed prior to making any final decisions. Its best that you call your health plan yourself. It helps to avoid any confusion and increases the chances that you get the most accurate information in order to avoid any future unexpected bills.
One word of warning,…
When calling your insurance company, it is customary for the insurance representative on the phone to attempt to dissuade you from going to an OON provider. This is because the insurance company saves money when you choose someone who is in-network and discounts their fees. Lower rates don’t always equate to less quality care but often times it can.
If your condition warrants a higher and more specialized provider, an OON provider may be the preferred option of choice.
In many cases (with physical or occupational therapy for example), conditions often resolve before the deductible amount is ever even reached so choosing an OON provider versus an in-network provider bears little or no consequence.
With a PPO plan u are paying for the freedom of choice so if there is a provider you like and you prefer to go to them, and wish the very best possible care for ur particular condition, you can choose them.
Remember its your body..it’s your health, it’s your choice.