A Preferred Provider Organization (PPO), is one of the many different plans that health insurance companies provide. PPO insurance is regarded as the health plan providing the maximum benefits, so long as you visit a healthcare provider that is in-network.
What Is PPO Insurance?
Preferred Provider Organization, or PPO, insurance is the least restricted level of private insurance plan. Commonly, PPOs are referred to as the plan with the most freedom. In short, PPO plans provide the most coverage because they offer coverage for in-network and out-of-network providers.
5 Types of Insurance Plans:
- HMO – Low deductible, Low premiums, Referrals required
- POS -Low deductible, Low premiums, Referrals required, Claim forms required for out-of-network providers, Out-of-network (OON) coverage
- PPO – Low deductible for certain plans, High premiums, Claim forms required for out-of-network providers, Out-of-network (OON) coverage
- EPO – High deductible, Low premiums, Referrals required for some plans
- HDHP with HSA – High deductible, Low premiums, Claim forms required for out-of-network providers
Additionally, PPO plans differ from other plans because they do not require a referral from a primary care physician before seeing a specialist. As long as you visit a doctor or healthcare provider within your network of approved providers, you should be covered. Many PPO plans also offer some form of coverage even when you visit an out-of-network provider.
Most PPO plans will most likely have a copay cost for every doctor visit until you have met your deductible. Some plans will not begin any monetary coverage until you reach a specified amount of out-of-pocket costs. Similarly, certain plans withhold full-coverage or partial coverage until you have reached your yearly deductible. For example, you have a PPO with a yearly deductible of $6,000 dollars and an out-of-pocket maximum of $8,500. For your plan, you must reach the deductible before receiving any aid in medical visit payments. Thus, you must pay out-of-pocket (at the time of your medical appointment) the full amount of the appointment. Once you have spent $8,000 in medical visits over the course of the year, they have agreed to pay 60% of appointment costs. Additionally, if you reach your out-of-pocket maximum of $8,500 within the calendar year, you no longer pay anything towards medical care and the insurance provider pays in full for the remainder of the year.
It is important to note that, depending on your insurance plan, certain medical visits may be covered, or partially covered, while others require 100% out-of-pocket payment.
Does My PPO Insurance Plan Cover Rehab?
Not all PPO plans will offer drug and alcohol treatment coverage. Most often when substance abuse coverage is permitted, there is a high deductible that must be met first. If you have a PPO insurance plan and are looking into addiction treatment, you should first call your insurance provider for more information regarding your plan.
PPO insurance plans are usually chosen and managed by employers. This means that you will most likely not have too many choices in which rehab you attend. However, since the coverage remains the same for everyone in the company—including upper management and the owner—you may have access to some higher-end services and facilities. These services may include amenities such as private chefs, equine therapy, acupuncture, as well as cutting edge therapies. There will most likely be out of pocket expenses and deductibles regardless of the facility you attend, however, the cost will still be significantly less than if you had no insurance coverage.
According to The Substance Abuse and Mental Health Services Administration (SAMHSA), the average stay in inpatient residential treatment is between 30 and 105 days. For outpatient treatment programs, the typical stay usually runs up to 120 days. Inpatient treatment tends to have a higher success rate since guests are able to completely focus on themselves and their recovery without outside distractions. Your length of stay in rehab, as well as whether it is inpatient or outpatient, will depend on your own individual needs, history, and terms and conditions of your insurance policy.