Learn how HMOs and PPOs differ when it comes to your pediatric surgery in Orange County.
Deciding on the right type of health insurance can feel like a daunting task. There’s so much to read through and so many different types of coverage options. However, perhaps the most important difference to pay attention to is whether or not your health plan is an HMO (Health Maintenance Organization) or a PPO (Preferred Provider Organization). While each policy gives you adequate coverage, they differ in how they give you coverage for your pediatric surgery in Orange County. Pick the right policy that’s best suited for your needs, and check out how an HMO and a PPO differ.
Health Maintenance Organization (HMO)
Pros:
- You never have to file a claim. With an HMO policy, you only see doctors within your network. That way there’s no need to file a claim. You go to the doctor, and your insurance company deals with the provider.
- With an HMO policy, you pay a lower premium and lower copay. With an HMO policy, you’re better able to save money.
Cons:
- You must go through your primary care physician before you’re able to see a specialist. While having a primary health provider can be beneficial, it delays the process when it comes to seeing a specialist. You can’t see any doctor anytime you’d like.
- You must see an in-network physician, which gives you less freedom. When it comes to your ability to see the doctor, you must see a doctor within your network or your insurance won’t cover it.
Preferred Provider Organization (PPO)
Pros:
- You have the freedom to choose any doctor that you like. As long as your doctor is within your network, you’re able to see any doctor that you want to whether a general practitioner, specialist, or hospital physician.
- You can see out-of-network physicians. While you may need to pay a bit more, you’re still given the option to see a doctor that isn’t in your network.
Cons:
- You must file a claim. After visiting the doctor, you’re responsible for paying the doctor directly and then going to the insurance company for reimbursement. This is especially true when you visit an out-of-network physician.
- It’s more expensive. With a PPO policy, you pay more. The greater flexibility of the PPO policy increases your monthly premiums and out of pocket expenses.
Don’t skimp on your health insurance coverage for your pediatric surgery in Orange County. Get the right coverage that best suits your lifestyle, whether it’s an HMO or a PPO policy. Contact the Pediatric Surgical Associates for all your pediatric surgical needs. Our pediatric surgeons in Orange County are experts at protecting your kids’ health and wellness!