What is Blue PPO?

Why would a person choose a PPO over an HMO?

Advantages of PPO plans

A PPO plan can be a better choice compared with an HMO if you need flexibility in which health care providers you see. More flexibility to use providers both in-network and out-of-network. You can usually visit specialists without a referral, including out-of-network specialists.

What is PPO good for?

A PPO is generally a good option if you want more control over your choices and don't mind paying more for that ability. It would be especially helpful if you travel a lot, since you would not need to see a primary care physician.

Are EPO and PPO the same?

A PPO offers more flexibility with limited coverage or reimbursement for out-of-network providers. An EPO is more restrictive, with less coverage or reimbursement for out-of-network providers. For budget-friendly members, the cost of an EPO is typically lower than a PPO.

What is the deductible for Blue Cross PPO?

$2,500 per individual / $5,000 per family. For non-participating providers: $5,000 per individual / $10,000 per family.

What does EPO and PPO mean?

A PPO (or “preferred provider organization”) is a health plan with a “preferred” network of providers in your area. ... An EPO (or “exclusive provider organization”) is a bit like a hybrid of an HMO and a PPO. EPOs generally offer a little more flexibility than an HMO and are generally a bit less pricey than a PPO.

What is BCBS BlueCard?

What Is the BlueCard® Program? The BlueCard Program is a national program that enables members obtaining healthcare services while traveling or living in another Blue Plan's area to receive all the same benefits of their contracting Blue Plan and access to providers and savings.

Do I have BlueCard?

BlueCard claim? A Go to blueshieldca.com, log on to I'm a Member, and then select the Claims tab to check the status of your claim. ... If you have other questions about the BlueCard Program, please refer to your EOC or COI booklet, or call the Blue Shield Customer Service number on your member ID card.

What type of insurance is blue card?

What is the Blue Card program? The Blue Card program is offered by the nationwide Association of Blue Cross Blue Shield. It does not apply to HMO networks or plans. The Blue Card program essentially extends a members network to Blue Cross Blue Shield providers in other States for PPO plans.

Does Blue Shield PPO cover out-of-network?

With the PPO plan, you can receive care from any of the physicians and hospitals within the plan's network, as well as outside of the network for covered services.

Is a PPO plan?

PPO, which stands for Preferred Provider Organization, is defined as a type of managed care health insurance plan that provides maximum benefits if you visit an in-network physician or provider, but still provides some coverage for out-of-network providers.

How does PPO reimbursement work?

Cost-sharing: You pay part; the PPO pays part. A PPO uses cost-sharing to help keep costs in check. When you see the healthcare provider or use healthcare services, you pay for part of the cost of those services yourself in the form of deductibles, coinsurance, and copayments.

What happens when you hit out-of-pocket maximum?

The out-of-pocket maximum is a limit on what you pay out on top of your premiums during a policy period for deductibles, coinsurance and copays. Once you reach your out-of-pocket maximum, your health insurance will pay for 100% of most covered health benefits for the rest of that policy period.

What does it mean when you have a $1000 deductible?

A deductible is the amount you pay out of pocket when you make a claim. Deductibles are usually a specific dollar amount, but they can also be a percentage of the total amount of insurance on the policy. For example, if you have a deductible of $1,000 and you have an auto accident that costs $4,000 to repair your car.

Is it better to have a deductible or copay?

Copays are a fixed fee you pay when you receive covered care like an office visit or pick up prescription drugs. A deductible is the amount of money you must pay out-of-pocket toward covered benefits before your health insurance company starts paying. In most cases your copay will not go toward your deductible.

Can you get a PPO through marketplace?

Yes. Any plan shown in the Marketplace includes these essential health benefits. This is true for all plan categories (all “metal levels,” including Catastrophic plans) and all plan types (like HMO and PPO).

Does EPO cover out of state?

EPO stands for "Exclusive Provider Organization" plan. As a member of an EPO, you can use the doctors and hospitals within the EPO network, but cannot go outside the network for care.

What is PPO in medical billing?

Introduction to preferred provider organization (PPO)

A PPO is a medicare arrangement where availing medical services like consultations, hospitals and medicines are all provided for a cost lesser than it usually is under this plan.

What is the largest PPO network in America?

The MultiPlan PHCS network is the nation's largest and most comprehensive independent PPO network. This network offers access in all states and includes more than 700,000 healthcare professionals, 4,500 hospitals and 70,000 ancillary care facilities.

Why are PPOs the most popular type of insurance?

Why would a person choose a PPO over an HMO? PPOs are one of the most popular types of health insurance plans because of their flexibility. With a PPO, you can visit any healthcare provider you'd like, including specialists, without having to get a referral from a primary care physician (PCP) first.

What are the two types of PPOs?