Preferred Provider Organization (PPO) Discounts: How Do They Work?

Organizing a health insurance plan is complicated but it needn’t cost the earth. Purchasers can benefit from a wide variety of healthcare insurance plans available, each with its own particular advantages and disadvantages – but how do you know which plan is best for you, and where can you find a health insurance package that offers value for money? One thing’s for certain – health insurance is essential. The cost of medical care in the United States is high and without insurance, you risk a huge medical bill.  

What is a Preferred Provider Organization (PPO Discount)?

One of the fast-growing, most popular types of plans is the Preferred Provider Organizations (PPO) plan. A PPO plan is the type of system where healthcare providers have an agreement with an insurance company so they can offer discounted fees to members of the organization’s plan. If you opt to join a PPO you can take advantage of a PPO discount on the cost of healthcare, whether you are having an emergency procedure, visiting the doctor for a check-up, or buying prescription drugs.

Under your health insurance plan, you gain full access to a network of health providers that operate under the same healthcare umbrella. The doctors, physicians, hospitals, and clinics that operate within the network agree to offer you – as a member of the network – good quality healthcare at reduced costs. As part of this agreement you commit to using these healthcare providers – it’s a little bit like “you scratch my back, I’ll scratch yours.” The health insurer gets a discount from the healthcare provider so it can pass this ppo discount on to the consumer in the form of lower premiums. In return, the healthcare provider gets more patients and therefore will pick up more money in terms of fees and will have a guaranteed flow of people through their doors.

For example, take a look at the following guide to sample savings with the UnitedHealthcare Choice Plus network – a PPO operating a Golden Rule health insurance plan where you can visit healthcare providers in the UnitedHealthcare Choice Plus group of physicians, hospitals, and clinics. With 780,000 professionals operating within the network, you will have plenty of choices if you need to visit a physician. In addition, there are almost 6,000 hospitals in the network.

What can you save? If you look at the example above, you can see that the provider discounts are from 50 to 90 percent. A doctor’s office visit that would originally cost, on average, $83.89 would come to $40.37 if you are a member of the United network. If you need an MRI scan you could save up to 69 percent, and for a lipid panel check up to 90 percent on the actual charge.

Discounts vary depending on the provider, geographic area, and the type of healthcare service you need – the discount prices given above are guidelines only and you need to investigate how much you can save by looking at the prices charged by each individual provider in your area. This is the same for any other PPO. The United network is available in most areas in the US but the availability of the plan may vary depending on which state you are in. Plus, a health care provider may opt-in or opt-out of the network at different times – it is up to you to check with the provider whether they are still operating within your PPO network at the time you need treatment. Usually, this can be achieved with a simple phone call to the organization in question.

If you want, you can choose to visit a provider outside the PPO network – sometimes it will be necessary to do this. Keep in mind, however, that the fees associated with this visit will be substantially higher than the fees offered by practitioners within the PPO discount network. But at least you keep the freedom to choose.

Other advantages of a PPO for you as a consumer are as follows: your deductible may be lower. When you sign up for a PPO plan you can usually benefit from this advantage. The plan also helps you budget for your healthcare spending throughout the year. You can limit the amount of money you spend within the year and if you reach this limit you can decide whether you want to continue using the plan or sign up for another.

Most PPO plans offer a wide range of healthcare facilities within the prescribed network. Pick a doctor’s office, a hospital, or an outpatient clinic within the network and benefit from lower prices. The advantage of a PPO plan is the amount of freedom you have to choose your healthcare providers. You do not have to pick a primary care physician and stick with them for your healthcare needs and referrals. Therefore you can access specialist care without having to first get a referral.