Understanding PPO Networks: How to Choose the Best One for You

“Know your options; choose the best PPO network to save on healthcare expenses.” -Unknown

Choosing the right PPO network, also known as a Preferred Provider Organization, can make a world of difference in your healthcare expenses. Whether you’re a family of four, a single individual or a small business owner, selecting the right network could potentially save you thousands of dollars. In this article, we’ll go over the basics of PPO networks and how to choose the best one for you.

The first step to understanding PPO networks is to recognize what they are. A PPO is a network of medical providers who have agreed to offer services at a discounted rate to insured patients. The insurance company will negotiate rates with these providers, so the patient pays less than the full charge of medical services. A PPO plan allows you to choose any provider within the network without a referral from a primary care physician. Additionally, you may still be covered if you see an out-of-network provider, but you may have to pay a higher percentage of the bill. With that basic framework in mind, let’s dive into how to choose the best PPO network for your needs.

Network Size

When considering a PPO network, size matters. The larger the network, the higher the chances of finding a provider that meets your needs. The volume of providers within a network contributes to the flexibility of the plan. Moreover, a large network has the potential to offer lower discounted rates. Typically, insurance companies will have these details readily available which will help you determine if the network will be effective for your healthcare needs.

Individual or Business

Selecting a PPO network can vary depending on whether you’re an individual or a business owner. For individual and group policies, different carriers may offer several “off the shelf” product lines to meet their customer’s needs. Business policies are typically customized by the insurance company since they cover more extensive networks and often require additional features such as comprehensive coverage across multiple regions or states.

Premium Costs

Premium costs generally increase with the size of PPO networks. PPO networks with more extensive coverage and more massive provider networks usually have higher premiums. Individual policies may not be updated annually, but group policies may have updated rates when the policy is renewed. Reviewing updated rates with your insurance company can help you stay on top of these adjustments and determine if paying more for a larger network is worth it in the long run.

Deductibles and Co-Payments

Another factor that impacts costs is deductibles and co-payments. Your deductible is the amount you pay out of pocket before the insurance company starts covering the cost of services. Generally, plans with lower deductibles have higher premiums. On the other hand, co-payments are the flat fees you pay for each medical service. This fee is usually the responsibility of the patient up-front, but the network’s discounted rates are applied after the payment is made.

Provider Network Composition

Every PPO network has different providers that make up its network, and it is vital to ensure that these providers offer the services you need. Most insurance companies have an online directory that lists the providers part of their network. The provider’s directory usually offers information such as provider specialties, clinic location, and provider availability. It is also common for providers that were part of one plan to leave that plan and accept a different plan within a different network. Cross-checking your provider choices through your network’s directory is a smart move to avoid surprises.

Conclusion

Choosing the right PPO network can be challenging since several factors such as size, cost, and composition contribute to the decision. Having a clear view of your healthcare needs gives you a better idea of the type of PPO network that works for you. Reviewing these components with your healthcare provider or insurance company is always beneficial and can lead you to the most cost-effective plan to fit your needs.

Still unsure about what to select? We can help! Our licensed advisors can help you navigate these options and provide recommendations that will directly benefit you. Cost comparison and benefit transparency between carriers are essential components of our information offerings. Contact us by phone or book a consultation through our website. Choosing a PPO network that works for you and your budget is well within your reach.