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Is a Preferred Provider Organization (PPO) the Right Choice for You?

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Written by:
Andrew Hall

Key Takeaways

  • PPO stands for Preferred Provider OrganizationA Preferred Provider Organization (PPO) is a health insurance plan that doesn’t require you to get a referral from a primary care physician to see other doctors. Most PPOs allow you to see any doctors or providers in their network. .
  • The PPO network of healthcare providers agrees to provide care at a specific rate.
  • PPO plans do not require you to choose a primary care physicianA Primary Care Physician is a doctor that oversees and monitors your medical care under some plan types. PCPs also may be responsible for referrals to specialists. (PCP) and do not require referrals to see specialists.
  • If you’re away from home, you can see any healthcare provider in the network you choose.

FAQs

If you see an in-network specialist, you can always visit another specialist or provider for a second opinion without a referral. If you choose an out-of-network specialist for the second opinion, your costs may be higher. It’s always best to check your network and see an in-network provider whenever possible.
An allowable charge is the calculated cost of deductible and coinsurance based on service. Providers that participate in the PPO agree to accept predetermined fees for services provided. When you see a provider outside of your PPO network, that provider does not participate in the agreement, and you may be responsible for higher costs. Using in-network providers allows you to avoid extra charges.