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I think the commenter means "you can have preferred access". PPO = Preferred Provider Organization. You have a better deductible/coinsurance/copayment for "in-
by haldujai 3y ago
I think the commenter means "you can have preferred access".
PPO = Preferred Provider Organization. You have a better deductible/coinsurance/copayment for "in-network" (preferred) providers who have negotiated their rates with the insurer (or accepted the insurance company fee schedule). You typically need pre-authorization for elective surgery and advanced medical imaging. You have the option to see someone "out of network" but with less coverage.
HMO = Health Maintenance Organization. Simple version is you don't get to choose your provider, you don't need preauthorizations and you have to go through your designated primary care provider to access specialists. For the most part you can only access providers within the HMO network if you want any coverage.
- zamfi 3y ago> you don't need preauthorizations To be clear, in an HMO you don't need preauthorizations from your insurance but you still need your (not necessarily self-selected) PCP to order care or refer you to a specialist.
- haldujai 3y agoNeeding a referral (an assessment by a physician that something is medically appropriate) is not the same as needing preauthorization (insurance company agreeing to pay) but in any case hence the following "you have to go through your designated primary care provider". Many PPOs and public systems work in the same way, that's more about judicious and appropriate use of resources than payment authorization.
- zamfi 3y agoYes, I was just clarifying because PPOs often do allow you to seek out a specialist without a referral, and without requiring preauthorization.