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What are the Advantages of a PPO Insurance Plan?

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  • Written By: Lainie Petersen
  • Edited By: Melissa Wiley
  • Last Modified Date: 02 November 2016
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A PPO insurance plan is a form of managed care health insurance that allows policyholders significant control over their health care decisions while reducing their monthly insurance premiums. More formally known as preferred provider organization plans, a PPO insurance plan allows health care consumers to choose their own doctors and, in many cases, obtain medical care without first having to receive permission from a primary care physician. In addition to the advantage of being able to obtain health care from providers of one's own choosing, a PPO insurance plan participant can control costs by choosing preferred providers. For health care providers, PPOs can be a good source of new patients, as insurance companies will direct policy holders to health care providers who participate in the PPO network.

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Unlike a health maintenance organization (HMO), which typically requires policyholders to work with only one primary care physician or practice and to receive referrals for all care through that physician or practice, a PPO policy holder has the option of choosing to work with providers of his own choosing and to seek health care services on his own. The PPO insurance plan, on the other hand, typically designates certain health care professionals as in-network providers of health care. When a policyholder needs to see a doctor, he will financially benefit by choosing a doctor who is in the PPO network. He may, however, choose a doctor outside the network, though he will likely have to pay more than he otherwise would if he had worked with an in-network doctor.

Another advantage of a PPO insurance plan over that of an HMO plan is that plan participants do not have to delay or forgo health care treatment if they are unable to secure a referral from their primary care physician. While there are certain high-cost medical procedures that a PPO insurance plan will not cover unless the plan participant receives pre-certification approval through his insurance company, for the most part a PPO insurance plan holder can book appointments and procedures with specialists without needing to secure permission from a third party.

For health care practitioners who wish to grow their practice, participating in a PPO insurance plan provides two advantages. The first is that the practitioner's services will become more attractive to individuals who have PPO insurance, as they will save money by using her services rather than those of an out-of-network provider. In addition, many PPO insurance companies regularly refer policyholders to network participants, ensuring her a stream of new, paying clients.

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