Doctors and other Healthcare Providers

Many insurance plans involve Preferred Provider Organizations (PPO). A PPO is a group of physicians, clinics, medical practices and hospitals who have agreed to discount their charges. This is not an HMO … their only commonality is that they have agreed to reduce the cost of their services for individuals insured under certain plans. They discount their fees because the health care environment is competitive and they want good customers like you.

You can find out if your plan uses a PPO Network on your id card or you can find your PPO online.

Captive type PPO managed care insurance plans cover more of the bill if you see a physician that is in the PPO Network. You can tell if your plan has this feature if your brochure refers to IN-NETWORK and OUT-OF-NETWORK pay rates. These plans provide a strong financial incentive for you to seek treatment by a provider listed in the PPO Network. Other plans include PPO’s on a passive basis which means there are still advantages of using a physician listed in the network but the advantages are not always substantial.

If you receive treatment by a PPO Network provider, be sure to identify yourself as a subscriber to the PPO Network identified in your brochure and on your insurance ID card. If a physician refers you to another physician, let the primary physician know that you would like referral to another Network provider.

Your bill will not be adjusted by the doctor or hospital, at the time of treatment. It will be re-priced by the Claims Administrator when you file the claim. Medical providers are not permitted to balance bill you for the difference between their standard charge and their discounted charge. However, there still may be co-pays and deductibles. Review your plan to be sure.

To find out more about your PPO, including their list of approved physicians and hospitals, please visit their web site from this page. Your brochure or ID card will indicate which PPO your plan utilizes.