Any laboratory or diagnostic test must be pre-approved by your HMO. The approval process can take up to several weeks. If you get sick and require hospitalization HMOs try to get you out as soon as possible because they lose money when you are in the hospital. However, if you are approved for a hospital stay it is covered 100% or near 100%.
PPOs allow patients to see doctors that are not part of a network at a higher cost. PPOs allow you to switch doctors with ease. Patients usually do not have to select a primary care physician but are required to pay a deductible. However, each PPO plan is different.
You may have to complete claim forms for some services and will get reimbursed a portion of the upfront money you paid. PPOs are a great option for people who want some independence in choosing their health care. If you have several health problems or like to get second opinions a PPO is the best option. A PPO is not a good option for those living paycheck to paycheck or who earn a variable income.