A Glance at Fee-for-Service and PPO Insurance Plans
By Art Gib
In today’’s world, where even the most basic necessities of life have become startlingly inflated–especially medical care–it is crucial to be sure that you and your family have health coverage that will ensure that you receive any medical care you need without hefting you off to the poorhouse afterward. Without it, seeing a medical professional can cost upwards of a hundred dollars–and that is not to mention emergency room visits, expensive prescriptions, extensive treatments, or major accidents.
But how do you know which health insurance plan is right for your family’’s unique situation? Let’’s take a look at two types.
The more traditional plan is called indemnity insurance, or “fee-for-service.” It operates much the same at automotive insurance does: each month, you pay into the cache, but in the event that you need medical treatment, you pay a certain deductible. The insurance covers the rest of the cost.
In the case of a visit to a doctor’’s office, this deductible is usually fixed. But when it comes to paying for a surgery or an emergency room visit (or anything along those lines), the payment is proportional to the total bill. Often, the patient is responsible for about twenty percent of the cost, while the insurance supplements the remaining eighty percent.
However, it is important to be mindful that the eighty percent generally does not get paid until the insured has provided the deductible amount. Sometimes the patient is even required to pay the bill in full and simply apply for a reimbursement, in which case he or she may have to cope with high out-of-pocket expenses before they receive the financial assistance they need.
But one of the most appealing aspects of “fee-for-service,” insurance is that the insured has the privilege of selecting their own doctors, hospitals, and specialists. They also do not require a referral from a primary care physician to see a specialist. This does provide more freedom and flexibility and cuts down on wasted time and expense.
Preferred Provider Organizations, or PPOs, are insurance plans which have negotiated a fixed low price for services with a certain network of physicians and health care providers. This does restrict the options for the insured, but the advantage is that a patient generally only pays about ten or fifteen dollars for a wide variety of services–even medical care with a specialist. Another perk is that patients do not need a primary care physician’’s recommendation to see a specialist in their network.
But if the insured stray outside of the network, then they must pay the bill out of their own pocket and apply for an eighty percent reimbursement from their PPO. There are even some times of PPOs–called EPOs, or Exclusive Provider Organizations–which will not reimburse you at all if you choose to seek care outside of the network.
There are a number of other options available to health insurance seekers, so as you look, be sure to be realistic about your family’’s needs and carefully study the advantages and disadvantages of each plan so you can best select the one that is right for you.
About The Author
To find the best health insurance for Texas residents, be sure to check out Ferriulo & Associates (http://usquotehunter.com/). Art Gib is a freelance writer.