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Home Home and Family Family Please help me understand my PPO
Please help me understand my PPO PDF Print E-mail
Written by Jeff CLine   
So many people get frustrated because they get surprise bills from a hospital visit or a procedure because they do not understand their PPO plan. We will help you understand the most misunderstood features of a PPO plan.
by JeffCline


So many people get frustrated because they get surprise bills from a hospital visit or a procedure because they do not understand their PPO plan. We will help you understand the most misunderstood features of a PPO plan.

Preferred Provider Organization or PPO is very popular these days. Many people prefer this insurance over and HMO. The reason being, that a PPO gives you freedom to pick any doctor you want. If you stay in network however, you get an added discounted cost.

The deductible seems to be a very confusing part of a PPO plan. Your deductible may be something like $5000. If you have any hospitalization or procedures you would be expected to pay the first $5000, before the insurance company shares any cost.

Co insurance is what we are talking about when we say the insurance company will "share " some expenses with you. Your co insurance may be 70/30, up to $2000. So you will pay 30% up to an additional $2000 out of your pocket.

So let's say you go in the hospital and your bill comes out to be $32000. You will need to pay $5000 so your balance is now $27000. The insurance company now expects you to pay 30% up to the $2000 limit. Now they will pay the rest.

So how does it look on paper? Total medical expense was $32000. Deduct your deductible that you are required to pay of $5000, that leaves $27000. Now your expected to pay 30% of the remains balance since your maximum is $2000, and 30% is $8100, you only pay $2000.

Now if you go to the hospital again in that same year you will pay nothing. Your deductible has been satisfied and your co insurance has been meet for the year. Your total out of pocket of $7000 has been paid.

I hope that now you can grasp and have a clear understanding of what your responsibility is. No more unexpected bills. No more calling the insurance company in frustration trying to figure out what they did wrong.

About the Author:

Call agent Jeff Cline today for cheap car insurance. . He can help you find the best rates. Jeff can also help with your health insurance needs as well. Call Jeff all day, anyday @ toll free 866-526-9669.

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