Question about PPO's

[ea_poe]

I've always had HMO type of coverage, where you simply make a co-pay for each visit. How do payments work for a PPO? If you have an annual max of say $2,000, what do you pay per doctor's visit? Do you pay the full amount until you reach that $2k or is there still a co-pay that applies against the $2k? (assume it is an in-network doctor) Any help would be great. Thanks.

Poe

[ShawnP]

Well it would depend if that $2000 was a deductible amount, if so, yes you pay the $2000 first and then after that depending on your plan structure, your insurance would pay the rest or the percentage amount agreed upon.  If there is no deductible and your out of pocket maximum is $2k, then you would pay the percentage, i.e. 20%, for each service until the $2k is met.  Also, some PPO's only have copays for office visits and anything else, like xrays or bloodwork would be subject to deductible/coinsurance.  It really depends on the plan that you sign up for.

I know this can be overwhelming, but I hope this helps some.

[hanaguchi]

The details vary from plan to plan but I am on a BC PPO and the way it works is that I pay my co-pay for office-visits (mine includes lab work). For hospitalization I have to pay the $2000 deductible and after that I am covered 100%. Some plans only cover a certain percentage after the deductible so you have to check for that.
Hope this helps

[ea_poe]

That's what I figured. Thanks for the help.

Poe