• 11
  Sep
  2009

• Direct billing from PPO Network

  
  Filed Under: Health Insurance

One of the first terms that an international student hears while trying to understand the health insurance policies in the USA is something called a PPO. Variously referred to as Preferred Provider Organization or Participating Provider Organization or Preferred Provider Option, the purpose of a PPO is simple. To make sure that direct billing for health care is easier, and your out-of-pocket expenses are kept at a minimum.

A participating or preferred member of a PPO would be any doctor, hospital, diagnostic laboratory or any other health care provider who has signed an agreement with the insurer or an administrator of health insurance. The agreement is to provide the clients of the insurer/administrator service at a reduced price. There are also agreements to provide service without charging any cash upfront and directly billing the insurance company (you still have to pay the deductible, of course).

The major advantage of being in a PPO is, because the size of the network is large, you will have a much bigger set of doctors to choose from.

One thing that you need to keep in mind: If you want/have to consult a doctor (either a primary care physician or a specialist) who is not within your network, you may have to end up paying more. It is a good idea to call your PPO network, and ask how much they will pay for a someone outside the network.

So, there it is. Another health insurance jargon busted. One less confusion before deciding to buy health insurance.

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