7 Steps to Maximizing Your PPO Coverage - Are you getting the best care out of your preferred provider organization (PPO) coverage? Here's how you can. A preferred provider organization (PPO) can offer you quality care and treatment, but are you getting the most mileage out of your coverage? Here's how you can do that.
1. Read the manual
Know what your policy covers and what it doesn't.
- Go through your plan description and learn how it works. Find out what your responsibilities are.
- Find out which medicines and treatments are covered, and which aren't.
- Does your PPO pay for special equipment such as crutches or a neck brace?
- Are you entitled to physical therapy in the event of an accident? If so, how much?
- Having a general sense of how your policy works is important. Otherwise, you may end up paying out more than you should.
2. Don't skimp
In many cases, you can opt for lower premiums if you're willing to pay higher co-payments and deductibles. If your budget allows, try to avoid this route. You may end up regretting it down the road. Should you suddenly require a hospital stay or major care, the costs may be more than you can afford. Never assume you are going to be well. Assume the opposite and plan accordingly.
3. Stay as healthy as possible
Many programs offer financial incentives for taking part in wellness programs. With some policies, you can score a discount if you quit smoking or lose weight. It's a sweet deal, and you should go for it. But even if you don't have that option, you should strive for wellness anyway. Staying healthy makes good physical and financial sense. You'll feel better and you won't be shelling out all that extra money.
4. Try to stay in your network
While PPOs allow you to see doctors who are out of your network, the co-payments for these visits are always higher. Sticking with network caregivers lets you hold down your out-of-pocket expense. This may not always be possible, though, especially if your network is small or if you need specialized care. But for routine visits, try to keep it in the family.
5. Use the programs
If your PPO offers a wellness incentive plan, sign up for it. If there's an applicable disease management program, then get on board. Get out your manual and read through the offerings. See how you can enhance your health on the company's dime. Not only will you feel better, but your premiums may even go lower as your insurer recognizes your efforts to stay healthy.
6. Speak up
Never settle for inferior coverage. When problems arise, be proactive. Never wait for a resolution to appear on its own. Get on the phone and politely complain to customer service. Never assume the person on the other end has the last say. Ask how you can elevate your complaint. See if your insurer has a formal grievance process in place. Most do. Use it if you need to.
7. Stay covered
Federal law says you can keep your company sponsored coverage for up to 18 months after leaving your job, if you worked for a company with 20 or more employees. If you're not moving into another job right away, you should hang on to your current coverage until your new coverage kicks in. This is usually a month after you have been at a job, but that can vary. It's more expensive because you have to pay the entire premium, but it's important to keep your insurance current. Try not to let it lapse. You never know when you will need it next.
SOURCES:
- Kongstvedt PR. Essentials of Managed Health Care. 5th ed. Sudbury, MA: Jonas and Bartlett Publishers, Inc.; 2007.
- Consumer Reports. Rating the health plans. September 2007;72(9):21-23.
- Pilzer PZ. The New Health Insurance Solution: How to Get Cheaper, Better Coverage without a Traditional Plan. Hoboken, NJ: John Wiley & Sons; 2007.
- Agency for Healthcare Research and Quality (AHRQ). Questions and answers about health insurance: A consumer's guide. Accessed: 03/29/2009
