What is a Consumer Owned PPO Network?

What is a Consumer Owned PPO Network?

Oftentimes you hear insurance agents talk about the “Network” or the “ PPO Network,” but do you really know what it means?  Sometimes my clients call and tell me their doctor has never heard of our network or “my doctor doesn’t take ABC Insurance.”  This isn’t their area of expertise.  My clients already know more about insurance than they really wanted to as it is my job to educate them. This empowers them.

Honestly, the Network is more important than the insurance company. Now I am not saying that insurance companies don’t differ in how they handle claims etc.  I am just pointing out that the Network of your plan makes all the difference.

Let’s break it down a little.  You have probably heard of the Cigna Network, or the First Health Network…perhaps the Aetna Network and the PHCS Network.  What you probably didn’t know is that there are networks within networks. Another way of stating it is there are Networks “under” networks.  They have different names, but usually start with the Original.  For example, there is Aetna…. Or Cigna or PHCS Multiplan.

Consumer Owned Network

What you want to look for is a nationwide network. One of the many reasons I prefer our flagship product and recommend it to any client, who qualifies.  It is a nationwide network, but the most important element about it, is that it is a consumer owned network.  What does that mean? Are you ready?  It means we, you and I get to take advantage of the network pricing, or the wholesale pricing, if you will, NOT the insurance company?  Think about that for a minute.  Let it marinate in your brain.

An oversimplification of the process is this.  ABC Insurance Company goes to the provider (doctor) and negotiates a lower rate for said providers services based on ALL their subscribers. (That means you and I, who have purchased the insurance.) So let’s say they negotiated a $75 rate for a doctor visit.  You go to your doctor and pay your $40 copay and you feel pretty good about that.  Meanwhile the insurance company now owes the balance of $35 for your appointment.  Hmmm…You are paying a pretty good premium for the right to pay this $40 copay, so it looks like the insurance company is the winner here.

Once again, this is like paying to self-insure; throwing good money after bad.  With our flagship plan, you own the network, so you get the wholesale or PPO network pricing of the $75.  If you choose a plan that pays $60 for a doctor visit, you are doing pretty well because you owe $15.   If you choose a plan that pays $80 for a doctor visit, you are still doing pretty good, coming out a head $5.  If you choose a plan that pays $160 for a doctor’s visit, you just bought yourself lunch too.