Preferred Provider Organization Plans

Introduction to Preferred Provider Organization (PPO) Plans

Preferred provider organization plans (PPOs) are a type of health insurance plan, in which the insurance company has contracted primary care physicians, specialists, pharmacies, hospitals, clinics, and other health care organizations. These organizations make up the insurance “network”. In-network providers are then known as “preferred” providers, giving plan participants a lower, agreed-upon “preferred” rate for their services. The insurance company will pay the full agreed-upon reduced rate, and the participant will cover any applicable deductibles or co-payments.  

If a participant sees an out-of-network care provider, they may still have a portion of their treatment paid for by insurance, but it will be a lower percentage than if they had gone with an in-network provider. In some cases, none of the treatments will be covered. It’s always best to check with the insurance company before seeing an out-of-network provider. You may also want to ask whether similar providers can be found in-network. 

Key Features of PPO Plans

Preferred provider organization plans are one of the most common types of health plans, as many workplaces offer them to their employees, paying a large portion of the monthly or annual insurance premiums on the employee’s behalf. PPOs are well-liked because they’re more flexible than other types of insurance, offering comprehensive coverage with a wide range of providers and services. 

Although encouraged to name a primary care physician, those enrolled in a PPO, participants are free to see any provider in their network without needing a referral. PPOs tend to have higher premiums, deductibles, and copayments than other types of insurance, but they’re also more flexible. Out-of-network care may even be partially covered, but if you get care from an in-network provider, you pay less out-of-pocket, and your coverage will be more exhaustive. 

Advantages of PPO Plans for Individuals

Some of the major advantages of preferred provider organization plans are:

• They have a larger list of in-network providers available for you to choose from, giving you more say in where you get your care
• Doctors and healthcare facilities in the insurance company’s network will all offer the same in-network price
• You don’t have to choose a primary care physician, which can be more convenient if you’re not able to see the same doctor every time you need care
• No referrals are needed to see a specialist, you can just book the appointment when you’re ready, which will save you time and money, as you don’t need to book in with your primary care physician first
• PPOs tend to offer more flexibility than other types of insurance, as you can go out-of-network to get the treatment you want, and will usually have at least partial coverage 

Understanding the Costs Associated with PPO Plans

While PPOs offer better flexibility and more care options, the premiums are generally higher than they are with other types of insurance. You will also be responsible for copayments at each appointment, and you will need to meet a deductible before your insurance coverage kicks in. Some deductibles can be thousands of dollars. 

You will also have to pay more out-of-pocket costs if you see an out-of-network provider who isn’t part of your insurance plan’s network. You may have to pay the full fee at the time of the appointment, and then file the claim paperwork yourself to receive a reimbursement from the insurance company.

Some types of therapy, holistic treatments, and care are not covered at all, while others might only be partially covered. Understanding your insurance plan is crucial before seeking care, so you don’t have any unnecessary financial surprises. 

How PPO Plans Cover Addiction Treatment and Mental Health Services

Preferred provider organization plans by law must cover addiction treatment, behavioral health care, and other mental health services to the same extent they would cover physical ailments. They may cover treatments and care including:

• Detox and medication-assisted treatment (MAT) services
• Inpatient (residential) mental health care and rehab services
• Outpatient treatments including partial hospitalization programs (PHP) and intensive outpatient programs (IOP)
• Evidence-based therapies like cognitive behavioral therapy, dialectical behavioral therapy, family therapy, and more
• Co-occurring mental health care
• Prescription medications 

Choosing the Right PPO Plan for Your Healthcare Needs

There are many different PPO plans to choose from, which have different network sizes, out-of-pocket costs, and services they cover. When deciding which PPO plan is right for you, you may want to ask yourself the following questions: 

• How often do you go to the doctor? Is your primary care physician in-network with the insurance company?
• Are there specific out-of-network providers you want to be able to access? 
• Do you need flexibility in your care?
• What are the deductibles, copayments, and premiums for each plan?
• Is flexibility or low cost more important to you? 

Navigating the Network: Finding Providers in PPO Plans

If you are part of a preferred provider organization plan but aren’t sure where to find the mental health treatment you need, you can always speak to your insurance company. Call the phone number on the back of your insurance card, and the representative you speak with will be able to give you a list of in-network providers and explain how coverage limits, deductibles, and copayments will work. 

If you’d rather read about it yourself, you can also look at your insurance policy rules yourself. Most insurance companies will have it all laid out online for you. Just log in to their online portal, and find out for yourself what types of treatment are covered, what percentage of the costs will be covered, and how it all works. 

At WhiteSands, we are also happy to speak to your insurance company on your behalf. With your permission, we can find out what types of treatments and levels of care are covered, and how much you’ll have to pay out-of-pocket, and we can explain it to you in simple terms. 

PPO Plans and Emergency Care

PPO plans are designed to save you money when you go to urgent care centers, hospitals, and specialists that are in-network with your insurance company. If your insurance is not accepted, but you still receive care, you’ll have to pay more out-of-pocket. This is not generally the case during a medical emergency. Your insurance will cover emergency care, even if you have to go to an out-of-network provider. If you’ve had a medical emergency, experienced a traumatic injury, or heart attack, call 911 or go straight to the closest emergency room. Your insurance will usually cover emergency room visits, unexpected hospitalization, and more. 

WhiteSands Treatment and Preferred Provider Organization Plans

Choosing WhiteSands means choosing comfort, safety, and high-quality, evidence-based care from trustworthy, highly trained, and licensed doctors, therapists, psychiatrists, and addiction experts. We offer customized inpatient and outpatient treatment programs, including:

• Medical detox
• Residential rehabilitation
• Dual diagnosis treatments
• Mental health care
• Medication-assisted treatment (MAT) programs
• Partial hospitalization programs
• Customizable intensive outpatient programs 
• Long-term aftercare

We are proud to accept many PPO insurance plans, making it easier for you to access the care you need to overcome addiction once and for all. To determine your coverage and find out more about what types of treatments we can offer you, please contact us by calling (877) 855-3470, or filling out our simple online insurance verification form. We’re here to make getting the help you need as easy as possible. 

If you or a loved one needs help with abuse and/or treatment, please call the WhiteSands Treatment at (877) 855-3470. Our addiction specialists can assess your recovery needs and help you get the addiction treatment that provides the best chance for your long-term recovery.