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PPO - Preferred Provider Organization

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PPO- Plans (Preferred Provider Organization)
With this plan you are free to use any physician within that insurer's network. The networks are quite large and you don't have to wait for for referrals or stay within one medical group. You also have the option of going outside of the insurer's network to any doctor however, you will pay a higher *copayment percentage. Most companies have a choice of deductibles associated with their PPO plans ($250, $500, $1,000, etc.) and varying *copay percentages. These choices directly effect your monthly premium (lower deductible corresponds with higher monthly premium).

This plan type closely resembles a Fee-for-Service plan. A PPO has arrangements with a network of doctors, hospitals and other providers who have agreed to accept lower fees from the insurer for their services. As a result, your cost sharing should be lower than if you go outside the network. In addition to the PPO doctors making referrals, plan members can refer themselves to other doctors, including ones outside the plan. This makes it a best-of-both-worlds option for many patients: lower costs in the network, but flexibility to leave the network if necessary.
If you go to a doctor within the PPO network, you will probably pay a copay (a set amount for certain services -- like $15 for a doctor visit or $10 for a prescription). Your coinsurance will be based on lower charges for PPO members.

If you choose to go outside the network, you will have to meet the deductible and pay coinsurance based on higher charges. You might also have to pay the difference between what the provider charges and what the plan will pay.