Share of Cost – Getting the best value under a PPO plan.
Understanding the network of providers is crucial when selecting a PPO plan. It can greatly affect the coverage provided under the plan. While PPO plans offer greater flexibility than HMO plans, they also come with higher premiums and deductibles. Therefore, getting the best value out of your PPO plan is essential, and using the plan network of providers is an excellent way to do that.
The network of providers consists of healthcare providers who offer services to the PPO plan’s members at a discounted rate. When you use an in-network provider, you will have to pay lower out-of-pocket costs and receive more significant benefits than an out-of-network provider. Most PPO plans benefit outside-network dentists, but they may reduce coverage for non-provider use.
As An Example
Let’s say you need preventive dental care and use a dentist within the plan network of providers. The plan may pay 100% of the cost. However, if you choose a dentist who is not in the plan network of providers, the plan may only pay 80% of the cost. This means you must pay the remaining 20% out of your pocket.
Furthermore, even if the PPO plan you are considering does not reduce its benefits for out-of-network dental providers, you still risk having a greater chance of UCR(Usual, Customary, and Reasonable) fees. This is because inside-network providers have mostly agreed to reduce their costs to stay within the plan, whereas UCR rates and non-providers have made no such concession.
To summarize, using the network of providers is crucial in getting the best value out of your PPO plan. It can help you save money on out-of-pocket costs and receive more significant benefits. Therefore, it is essential to understand how the network of providers works and choose providers within the network whenever possible.