2016 is the year when finding your provider in a PPO network is a big challenge - and in some states such as Texas, it is nearly impossible to even find a PPO. HMO's are becoming the wave of the future it seems.
The reason for selecting a PPO has traditionally been that you could go out-of-network if you were in a situation where that was important to you. You would have lower out-of-pocket costs for using in-network providers, but if you chose to opt-of-network the cost was in the range of twice the lower in-network exposure. However, in 2016 many plans increased the go-of-network deductible, reduced the co-insurance they pay and, most dramatically, put no limit on your maximum out-of-pocket. That means you could be paying 50% of your out-of-network charges with no cap. In this scenario, if you had a $500,000 medical bill with out-of-network providers, you would be responsible for as much as $250,000.
So if you are even considering going out-of-network for any care, be sure to check your policy as each carrier has a different approach to this. It's certainly something you want to be aware of before you receive a surprise bill. To read about other's experiences with this and other out-of-network exposures, click here, for an article that appeared in Time magazine.