| PROVIDERS
AND PPO's |
| Whats
the difference between traditional plans and PPO plans? |
| What
is a PPO? |
| Why
choose plans using PPOs? |
| How
can you tell if a plan uses a PPO? |
| How
to find PPO doctors and hospitals. |
| What
are different types of doctors? |
|
| Q. |
What’s
the difference between traditional plans and PPO plans? |
| A. |
Traditional or indemnity plans
tend to be more expensive because they give the same level of
benefits no matter which provider is chosen (customers don’t
have to use specific network doctors or hospitals).
Plans using a PPO (preferred
provider organization) allow customers to choose any
qualified doctor; however, customers may have less
out-of-pocket expense when using doctors or hospitals in the
PPO network. |
|
| Q. |
What
is a PPO? |
| A. |
A PPO is a network of
credentialed doctors, clinics, hospitals, and other
health-care facilities and providers that are contracted to
provide medical services at pre-negotiated fees. |
|
| Q. |
Why
choose plans using PPOs? |
| A. |
PPO Benefit plan designs usually
cost much less than traditional or indemnity plans while
providing coverage for eligible expenses
no matter what qualified doctor you select. PPO Benefit Plans
allow customers to help lower costs and reduce out-of-pocket
expenses when choosing PPO network doctors. |
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|
| Q. |
How
can you tell if a plan uses a PPO? |
| A. |
Customers can check the Contract
to determine if their plan utilizes a PPO. Choosing providers
from that PPO network may mean less out-of-pocket expense for
the insured. |
|
| Q. |
How
to find PPO doctors and hospitals. |
| A. |
Customers have several options
available to them for finding doctors and other providers that
are contracted with the PPO network their plan uses. The most
accurate and up-to-date way is to ask their current doctor or
other health-care providers prior their appointment and on the
date of service to determine if the provider is part of the
PPO network. |
|
| Q. |
What
are different types of doctors? |
| A. |
There are many different types
of doctors and/or specialists to choose from. A primary doctor
can understand your health requirements and help refer you to
other doctors when necessary.
Some types of primary
doctors:
- Family practice: treats all
family members (child or adult); may include maternity
care
- Internal medicine: diagnoses
and treats nonsurgical disease in adults
- General practice: provides
service that’s not limited to a specialty
- Pediatrics: specializes in
caring for and treating illnesses and diseases in infants,
children, and adolescents
Specialists for women:
- OB/GYN: a physician
specializing in obstetrics and gynecology for women
- Certified nurse midwife:
advanced practice nurses which specializes in women’s
health-care needs throughout life (prenatal, labor and
delivery, and postpartum care for "normal"
pregnancies)
- Nurse practitioners:
advanced practice nurses studied in programs specific to
women’s health-care including common gynecological
problems, routine screenings, and family planning
Other areas of specialty:
- Anesthesiology: anesthesia,
either general or spinal block for surgeries and some
forms of pain control
- Cardiology: heart disorders
- Dermatology: skin disorders
- Endocrinology: hormonal and
metabolic disorders
- Gastroenterology: digestive
system disorders
- General surgery: common
surgeries involving any part of the body
- Immunology: disorders of the
immune system and allergies
- Infectious disease:
infections affecting the tissues of any body system
- Nephrology: kidney disorders
- Neurology: nervous system
disorders
- Oncology: cancer and some
other malignant (growing worse - resisting treatment)
diseases
- Ophthalmology: eye disorders
and surgery with services provided by an ophthalmologist
(MD) or optometrist
- Orthopedics: bone/connective
tissue disorders
- Otorhinolaryngology: ear,
nose, throat disorders
- Physical and rehabilitative
medicine: coordinate physical therapy for return to
optimal functioning in individuals with musculoskeletal
and neurological disorders (i.e., low back injury, spinal
cord injuries, and stroke)
- Psychiatry: emotional or
mental disorders
- Pulmonary (lung):
respiratory tract disorders
- Radiology: evaluation of
X-rays and related procedures (such as ultrasound, CT
scan, and MRI)
- Urology: male reproductive
tract and both male and female urinary tract disorders
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