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PPO vs. HMO

PPO vs. HMO: What to choose in the workplace

Posted by on Feb 15, 2016 in PPO vs. HMO | 0 comments

Since before, the old adage health is wealth has been the mantra of many workplaces across the U.S. For them, a healthy workplace means a healthy business, and taking care of their employees’ health means taking care of their bottom line. Today, there are many options that employers and employees may choose in order to secure their precious health. Among them are HMOs (Health Maintenance Organizations) and PPOs (Preferred Provider Organizations).

PPOs and HMOs are both managed care plans, which means the organization contracts medical professionals and health facilities to cover for their policy holders at a much lower cost. The first thing to know in choosing the best PPO or HMO is to check first its credibility. In some cases, PPOs and HMOs deprive doctors and other medical service providers of the pay they are entitled. According to Texas Prompt Pay Act, this practice is considered illegal, and doctors and health care providers have the right to take legal action to seek compensation.

Health Maintenance Organizations

When you are enrolled in a HMO, you will be assigned a primary care physician (PCP) who will manage and coordinate all your health needs. Whenever you need to consult with a specialist or undergo certain treatments, the approval of your PCP is needed first. Also, you will less likely be covered if you will render services outside your network. However, unlike PPOs, HMOs usually have lower monthly premiums. You can also expect cheaper out-of-pocket costs in HMOs.

Preferred Provider Organizations

Individuals enrolled in PPOs should deal with higher monthly premiums and higher, more frequent out-of-pocket medical services. These are in exchange of PPO’s flexibility when it comes to getting the services you need. For one, you will not be required to have a PCP, and a referral is not needed for you to see a specialist. Unlike HMOs, PPOs allow you to render services that are out of your network.

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