HMO or PPO: What is the Difference?: Family Medical Center of LaGrange, 5201 S Willow Springs Rd, LaGrange, IL 60525, 708-482-8088

Family Medical Center of LaGrange; 5201 S Willow Springs Rd, Suite 300; LaGrange, IL 60525; 708-482-8088; Steven K. Sauerberg MD, Michael F Dupont MD, Scott D Robertson DO, Daniel Chen DO, Judith Lin MD, Deborah Sleeper PA-C;

Phone Family Medical Center of LaGrange at: 708-482-8088

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(708) 482-8088

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Family Medical Center
of LaGrange
5201 S Willow Springs Rd
Suite 300
La Grange, IL 60525

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(708) 482-9034

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(866) 492-3191

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HMO or PPO: What’s the difference?

HMO - Health Maintenance Organization

An HMO is a prepaid health insurance plan which includes an organized network of healthcare personnel and facilities which offer a wide range of services including preventative care to its members. An HMO provides most aspects of health care that a member may need. When an HMO manages your healthcare, however, they usually require you to use only the doctors and hospitals belonging to its network. If you utilize a doctor or hospital that does not belong to the network, the care you receive usually will not be paid for unless the care was authorized ahead of time by your HMO or was for emergency care; even then it may not be paid for.

PPO - Preferred Provider Organization

A PPO encompasses features of an HMO and private insurance. Plans are usually made up of a pre-selected group of physicians and hospitals that have contracted with insurance companies or employers to provide medical care at a discounted rate. Patients are encouraged to use "in network" providers or risk paying a greater percentage of the bills. Often, there is a "co-payment", or small fee required each time you visit your doctor. You may choose doctors and hospitals that are not in the PPO network for a slightly higher out-of-pocket fee.

PCP - Primary Care Physician

Many managed care plans will require you to choose a PCP to oversee, or "manage" your medical care. This doctor could be a family doctor, internist, pediatrician, or obstetrician/gynecologist, and would be the gatekeeper of your health care - the first person you should see for any illness. This physician would then either treat you or refer you to a specialist when necessary.

Helpful Hints

If you have questions, contact your insurance company.

Be sure to check before any procedures and talk with your doctor as they are your managed care providers and have a staff dedicated solely to insurance needs.

Family Medical Center of LaGrange, Ltd.
5201 S. Willow Springs Road Suite 300
La Grange, Illinois 60525
(708) 482-8088

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