A PPO health insurance plan is basically an insurance plan that is supported by a preferred provider organization. This preferred provider organization ("PPO") is a network of providers that have each agreed to provide healthcare services to members of the PPO at lower rates than they would otherwise charge. The providers do this in exchange for a larger referral base from the entities that they contract. These entities are insurance companies.
The hard work of negotiating and contracting with medical providers is done by the networks who then charge a fee to the insurance companies for utilizing their network. In this manner, the insurance companies can lower their costs for medical claims by having to pay reduced rates to the medical providers. In addition, policy-holders also benefit by having access to these same rates and reduced prices for any and all out-of pocket healthcare costs that they utilize. Whether for deductibles, services not covered, etc. the consumer also benefits from these reduced fees.
In addition, PPO health insurance plans also allow for utilization outside the network of the contracted medical providers. They allow the access, but they attempt to persuade policy-holders from going outside the network by lowering the benefits for any such utilization. In this manner, consumers are enticed to utilize as much of their healthcare services from network providers, which lowers the costs to the insurance company, lowers the out-of-pocket to the insured, and in theory lowers the health insurance premiums of consumers.
PPO health insurance plans are fairly flexible and allow plenty of choices for consumers. There are many health insurance companies today that provide these types of plans and are also done in conjunction with high-deductible and/or savings accounts.
There are also many, many medical networks in existence today and they must be maintained, expanded, and constantly kept with low contracted prices. There are also networks that lease access from one another in order to provide more expansive coverage. There are good networks and there are also bad ones. There are even health insurance companies that invest and build their own medical networks.
Occupation: Founder
The son of Cuban immigrants, Rene Luis was born in Puerto Rico in 1965. The oldest of seven children, he moved to Miami, Florida along with his family in 1974.
From an early age, Rene’s intellectual curiosity was apparent. As a child, Rene was always looking for answers to difficult questions. At the age of six, his father gave him a magnet set that he spent countless hours with, creating magnet-powered toy cars. Although life took him in a different direction, his desire as a child was always to be a scientist.
Early in college, Rene began creating small businesses out of his ideas, one of which was a manufacturing company for products that he himself invented, designed, and marketed. One such product was a shoe gadget that he marketed to children and athletes. An accounting major in college, the business was so successful that he considered leaving school and concentrating full-time on the company. After much thought, he decided to continue his education, rationalizing that his inventions would way until he finished college with a Bachelors in Accounting.
With a father and grandfather that both studied economics and accounting, Rene redevoted himself to his studies, and took great pride in his work. Although he decided to focus on his university career, the entrepreneurial bug apparent since childhood would serve him well later in life.
Once out of college, Rene went to work with a small accounting firm that specialized in forensic accounting. Formed by the previous partners of some of the biggest accounting firms in the country, Rene had the opportunity to work and learn from seasoned veterans, an experience he found at once challenging and rewarding.
After 4 years, Rene left to pursue new challenges at a larger accounting firm. It was there that he began to consult in healthcare and became immersed in researching the industry and gaining the knowledge that would later serve him at VitalOne.
As he researched health insurance and the industry, he became interested in how coverage reaches some, and fails to reach others. He worked to understand why insurance is needed and became a strong believer that consumers could be savvier about their healthcare if they approached it as they do every other industry. Fair market value is a common consideration in most industries, it should be no different when shopping for health insurance.
During that time, he also began to see how difficult it was for individuals and families to find affordable health insurance on their own. Whereas this type of information was readily available to businesses and corporations, it was not available to the individual and family. The time and effort weren’t invested to service this demographic. This, he thought, was not a problem, but an opportunity.
That is why VitalOne Health was created, to help consumers navigate the transition that is currently taking place from employer-based health coverage to individual coverage.
At VitalOne Health, Rene’s sole passion is to provide healthcare for everyone. Through education and consultation, VitalOne’s focus is to help consumers attain the health insurance coverage that is right for them.
Rene has now been working in health care for over fifteen years. His intention in forming VitalOne was to be able to better serve a growing market of individuals and families that have truly been underserved until now.
According to Rene, “Our opportunity is to better serve you honestly and effectively. Ultimately, we believe that the role of a health insurance agent will be ever more important in the future. Yet, with all of the technology and product offerings that we present, we must first earn each and every member’s trust and confidence.”
Author RSS Views:
Print this article
Ask about this article