What Are the Disadvantages of a PPO?


Quick Answer

Disadvantages of a preferred provider organization health insurance plan include paying deductibles, co-insurance fees and out-of-pocket expenses, according to The Florida Times-Union. Policyholders also have to pay the rates for medical facilities and doctors outside of their networks, notes MedicareHelp.org. There could be higher co-insurance fees and deductibles if an individual decides to go outside of his network for medical care.

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Full Answer

Depending on the PPO health insurance plan, there might be unusually low limits on how much the company pays for health care, notes MedicareHelp.org. Unless they have specific types of health conditions, policyholders might not have access to much out-of-network coverage with a PPO plan.

Advantages of PPO health insurance plans include gaining access to a large number of physicians and health care facilities, having more of a say in which doctor to see and not needing a referral before seeing a network health specialist, according to The Florida Times-Union. Policyholders also have the ability to negotiate fees.

Before deciding whether to sign up for a PPO plan, a person should ask how he is screened for approval and determine how well-qualified network physicians and medical care facilities are, notes MedicareHelp.org. Should a person not feel a PPO plan is right for him, he might prefer a health maintenance organization plan, states Health Insure.

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