Question:
PPO vs. POS? what are the differances between the two?

My insurance policy has just been switched from a PPO to a POS.. what do the two mean? what are their differances?    — Kate D. (posted on August 18, 2002)

August 18, 2002
PPO is preferred provider organizations and you get the biggest of savings if you go to a contracted physician, which most doctors will contract for PPO. You choose who you want to go to and you do not need an authorization from a pcp or medical group. If there is a co-pay, then you will not have to pay any other money for your visit. The doctor's contract states that he will accept the contracted amount. If the doctor is not contracted, then they will usually pay 50% of the bill and it is concidered out of network. You will be responsible for the remainder of the bill. You will need a pre-certification in most cases for surgical procedures such as what you see in bariatrics. There are even, in some cases, deductables that need to be met. It all depends on your individual policy. POS is point of service. You will have a pcp and sometimes an IPA medical group (which is the HMO side of it). If you get a referral to a doctor who is contracted with the medical group, then you usually have to pay only a co-pay. You will definitely need to get an authorization for any surgical procedures. Now you can also go to any doctor you want like a PPO, but you will have a deductable that you will have to suffice. If you have a 2500 deductable then you will usually have to suffice that before they will pay a portion of it. Now if they pay a contractual amount of 20-80 or 30-70 depending on your policy. Meaning the lower amount is your responsibility, then that is what you will pay after your deductable has been met.
   — Sue A.