Preferred Provider Organization (PPO)



A preferred provider organization, or PPO, is a plan for those who want to choose their providers specifically. PPOs cost more an an HMO, but you pay for the option of hand selecting the doctors, hospitals, and specialists you receive care from. You have a network, with in-network discounts, but you are permitted to choose out of network providers. A primary care physician is recommended but not mandatory for a PPO plan. Unlike an HMO, you choose your own specialists and other types of medical care without having to get a referral from your doctor (if you have one).

How to Know If A PPO is Right For You

Some individuals may be interested in a PPO plan if these options sound better than having your health care decided for you. Others like the structure and convenience of relying on a doctor to select their health care, but you may want more freedom to choose a provider with whom you feel more comfortable, is closer to home, or for any other reason. The options you have when you select a PPO plan are:

  • The ability to keep the physician you are currently using
  • The freedom to choose your own providers without a referral or approval from a physician and insurance first
  • The ability to use services or providers that are not covered in-network
  • The option of having a primary care physician (or not)
  • Personally managing your own care

Every individual may not feel comfortable with having so many options. Some reasons that may not make a PPO sound like the plan for you are:

  • Increased medical expenses
  • You would rather not manage your own care
  • Less government restrictions than HMOs
  • Not wanting to be billed by the provider

 

Sources:

1. California Office of the Patient Advocate, “What’s a PPO?” http://opa.ca.gov/healthcare/health-plan/what-is-ppo.aspx