What are the advantages and disadvantages of a PPO?
The advantages of a PPO program is that you can choose pretty much any doctor you want. And you don't have to have pre-authorization to go to that doctor. As an example, let's say that you start having migraine headaches. Under a PPO program, you can go right to a neurologist on your own. You can find a doctor who's a neurologist in your local area and you can go right to that doctor. That doctor will potentially ask you to have an MRI or a CAT scan. It's done right away with the PPO program. Under an HMO program, you go to a doctor, that doctor might say, "No, let's try giving you pills first. Let's try for several weeks to see if this works or if that works," but may not want to spend the money to authorize you to go to a, to have an MRI on the spot. The good part of that is it saves the HMO money, but on the bad side of it is that you might have a small tumor that's getting bigger every day and it could've been taken care of a lot earlier. So PPO programs typically give you immediate coverage, you can pick your own doctor, pick your own hospital, you're not under any confines as you are with an HMO. The disadvantages of a PPO plan is that there will be out-of-pocket expenses. As an example, you will have deductibles to pay, you'll have, potentially, what they call co-insurance, which means that after the deductible is satisfied, the insurance company may only pay 7% of your bill, you'll have to pay 3%, until you have another $5 or $6 out-of-pocket. So, for a person who doesn't make a lot of money, a PPO plan might mean that you are going to have a lot of out-of-pocket, like $8, $9 potentially. To a person who's got a lot of money in the bank, that person may say, "I'm willing to spend $7 or $8 to have choice of doctors that I go to." So as people start making more money, I usually find that more and more people choose the PPO networks.
