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In case you are looking for a comprehensive type of health coverage with much room for flexibility that still has a reasonable price-tag, a PPO insurance plan may be just the thing you need to cover your health needs.

Preferred Provider Organizations represent a network of medical workers, facilities and other professionals that are contracted by the insurance company in order to get more competitive fees for their customers. So those who are getting their medical services within the specified network will be charged with lower rates than if looking for them outside. However, you can still receive medical coverage outside the network too, only that your rates will be higher compared to what you get within the network.

PPOs can be regarded as a mix of traditional indemnity health plans and later-developed managed care options. In what concerns the network organization of medical services, PPOs are quite similar to HMO insurance plans. However, when you get a PPO plan, you aren’t required to choose a primary care provider (PCP). It’s the main difference between these two quite similar health insurance plan types. And since there aren’t any PCPs in PPO plans, you aren’t required to provide a referral when addressing any given specialist within the network. And when you receive your medical care in a facility or with a specialist outside the specified network your copayments will be considerably higher, but you still will receive partial coverage. (more…)

In the midst of all the heated debate about healthcare reform, there is one element that tends to get slightly less publicity. Yet, when it comes down to making the reform work, it is one of the most important changes to push through both the House and the Senate. To understand the issue, we need to go back to the Supreme Court decision in United States v. South-Eastern Underwriters Association which, in 1944, allowed the federal government to apply antitrust laws to insurance companies by extending the Commerce Clause in the US Constitution to break up abusive monopoly control. For many years, the lack of competition had allowed South-Eastern to fix outrageously high premium rates and to defend their monopoly through intimidation and coercion in six US states. When the Supreme Court finally signalled a potential end to these abusive practices, the McCarran-Ferguson Act of 1945 appeared. The key provision exempts insurance companies from the general run of federal laws imposing antitrust limits so long as each state puts local regulations in force. This has produced a patchwork of state laws which, to a greater or lesser extent, encourage free competition between insurance companies.

It is an undisputed fact that, as competition declines, the remaining one or two suppliers in a market have the power to abuse their dominant position. The results are usually higher prices, lower quality products and poor service standards. The interests of the consumer are lost in the rush to extract the maximum possible profit. In the healthcare industry, consumers have been penalised as insurers refuse to accept people with pre-existing conditions and refuse renewal of policies if expensive longer term treatment appears necessary. You cannot have failed to notice the steady increases in the premium rates – in fact, there has been a slightly faster rate of increase over the last year despite the fact of the recession. This is made possible because there is a lack of real competition between insurers in the majority of US states. The House has already included provisions in the bill to repeal this exemption from federal regulation. The Senate is now about to debate the same issue. Without this repeal included in the final law, insurance companies will be able to continue fixing prices and dividing up the market as it suits them. You will remain helpless victims. With the repeal in place, insurers will suddenly have to compete with each other. This should drive down premium rates and improve the quality of the service delivered. However you look at it, you will benefit directly. (more…)