Preferred Provider Organizations (PPOs)

If you're an employee working for a company of good standing, you've probably heard of the term “PPO” that's usually discussed along with the many health benefits provided by your employer. PPO stands for Preferred Provider Organization, which is actually a health plan contracting a network of medical service providers available in case you need some tuning up. Referrals and primary care physicians are no longer required to approach PPOs.

Depending on your customized health plan, you might have to shoulder annual deductibles and co-payments upon visiting a member of your company's PPO. However, opting to stick to your family doctor or a medical specialist not in the preferred network will mean more deductions to your health privileges. Going out-of-network means you'll have to pay the doctor directly and file a claim with the PPO for reimbursements.

Health insurances also come in the form of HMOs. You shouldn't confuse PPO with HMO, or Health Maintenance Organization. Unlike PPOs, HMOs do not give reimbursements to employees who consult with doctors outside of the network. HMOs also require a referral from your primary care physician to see a specialist and have your medical expenses covered. Filing a claim with the HMO beforehand is also necessary to receive payment from your company.

PPO is just one of the many words you'll encounter concerning health benefits. Don't just sign agreements without reviewing their terms.

Everything You Need to Know About Dental Reimbursement with PPO

Preferred provider organization or PPO is an organization of health care providers or offices that provides managed care under an agreement with an insurance company. Managed care refers to the methods used by health care providers (like dentists) intended to reduce the cost clients have to pay. It does not intend to reduce the quality of the service but only to look for all possible means to provide the service at a low cost.

Most employees who have a direct reimbursement plan prefer dentists participating in a certain PPO for a number of reasons. Considering that they offer dental services at a much lower cost, they are most likely willing to negotiate the amount clients will claim for reimbursement. This will allow clients to pay less out of their pocket, sometimes much of it are already covered by the insurance.

This makes PPO participating dentists very different from regular dentists. Non-PPO-participating dentists would normally provide services at a fixed price. The reimbursement that comes with the client's plan will also be inflexible, taking much of the cost out of your savings. Clients might be obliged to pay more if they have a traditional dental plan because it comes with a deductible.

Most PPO-participating dentists will require clients to present an ID card provided specifically for enjoying PPO plans. They provide dental services even to clients whose plans have deductibles or not direct reimbursement. However, clients are obliged to cover the deductibles first before plan covers eligible dental expenses.