Wednesday, April 6, 2011

Medical Billing And The PPO Plan

Medical billing is the process of collecting fees for medical services. A medical bill is also called as a claim that has to be collected from the insurance company. There are different types of insurance plans. What is the PPO plan? PPO is a term used in health insurance that stands for Preferred Provider Organizations. It is a managed care organization of medical doctors, hospitals, and other health care providers who are associated with an insurer agent/administrator's clients to provide health care at reduced rates. It is today one of the most preferred kind of health care plan in the country. A preferred provider organization is sometimes also referred to as a participating provider organization.

More than 50% of the insured population in the US have chosen to go for the PPO plan. Its popularity is mainly because of the fact that in this system, doctors / hospitals have made an agreement with the insurance companies to offer discounted fees to the company's members.

The primary advantages of going for the PPO insurance plan are,

Its not mandatory to maintain a primary care physician

Can directly see a specialist without referral

Freedom to choose own doctor / hospital

The main advantage of going for a PPO plan is that one can choose a health service provider from outside the provider list Another less popular system is called an (EPO) exclusive provider organization (EPO), wherein if you seek care from a non-preferred provider there is no coverage at all. One must remember that with freedom to choose will always mean more expensive medical bills.

There are many types of PPO plans and the actual benefits depend on different factors like,

Monthly premium amount

The amount of coinsurance obliged to pay,

Whether treatment from the network/ outside

Annual deductible amount

What are the other features of a preferred provider organization? They generally include services of review of the patient records by the company representatives to ensure that there is no foul play. In the case of non-emergency admissions, an approval is taken from the insurer in advance.

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