Understanding Your Medical PPO Network: How to Get the Best Care for the Best Price

Your PPO plan gives you power — here’s how to use it wisely

You’re enrolled in a medical plan that utilizes a PPO Network — one of the most flexible healthcare options available. That flexibility allows you to choose your own doctors, specialists, and hospitals without needing referrals or approvals.

But to get the best care and the best price, there’s one guideline that can save you thousands every year:

Stay in-network whenever possible.

Here’s what that actually means, why it matters, and how to make your PPO work harder for you.

What “in-network” and “out-of-network” really mean
Every PPO medical plan includes a list of doctors, clinics, labs, and hospitals that have agreed to provide medical care at discounted, pre-negotiated rates.

In-Network Providers
These providers contract directly with your PPO network. You’ll pay lower out-of-pocket costs, enjoy predictable pricing, and your claims are filed for you automatically.

Out-of-Network Providers
These doctors and facilities do not have a contract with your network. You can still see them, but expect higher costs and more paperwork — and in many cases, the provider can bill you for the difference between their full charge and what your medical plan PPO contracted rate pays.

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Good to know:
Emergency services are always treated as in-network, no matter where the emergency occurs. This is protected by federal law.

Example
In-Network Provider

• Provider Full Charge: $200
• Network Negotiated Rate: $150
• Insurance Benefit Pays the Provider: $100
• Amount You Owe Provider: $50

You saved $50 using an in-network provider.


Out-of-Network Provider

• Provider Full Charge: $200
• Insurance Benefit Pays the Provider: $100
• Amount You Owe Provider: $100CTA:

Why staying in-network matters
Choosing in-network care isn’t just about price — it’s about avoiding surprises.

When you stay in-network:

• You receive lower, pre-negotiated rates for services
• Claims are handled directly between the provider and insurance company
• You avoid “balance billing,” where providers charge you the difference between their full charge and the PPO contracted rate

Example:
An imaging scan might cost $250 at an in-network facility but $1,200 out-of-network. One quick confirmation call can make a dramatic difference.

Understanding “balance billing” — an important PPO concept
Balance billing is when an out-of-network provider bills you the difference between the provider’s full charge and the PPO network negotiated rate.

• Provider Full Charge: $200
• Network Negotiated Rate: $150
• Provider Balance Bills You: $50

In-network providers cannot do this.

The PPO contracted rate is final, predictable, and contractually locked in.
This is one of the biggest financial protections of staying in-network.

How to find in-network care
Finding affordable care should never feel like guesswork. Realm Health makes it simple:

• Call Member Services (844.802.3842) for help locating in-network providers
• Use your BenefitsApp to search for doctors, labs, urgent care centers, and hospitals
• Always confirm your provider’s network status before your appointment

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Call Realm Health Member Services

Pro Tip:
Search using the PPO Network Name printed on your ID card (such as Cigna PPO, PHCS, or Multiplan). Searching “Realm Health” will not bring up accurate results — providers are credentialed through the network, not us.

Your PPO network may vary based on your specific plan
Different medical plans may use different PPO networks. This is normal and depends on your selected coverage.

Your ID card will clearly show your network name. The PPO name and logo are located at the top — that is the name to use when verifying or searching for providers.

If you're ever unsure, Member Services will confirm it for you in seconds.

Can you see an out-of-network provider? Yes — with a few things to keep in mind
PPOs are built for flexibility, which means you can visit any provider you choose. Just remember:

• Your out-of-pocket costs will likely be higher
• You may need to submit your own claim
• Plan benefit payments may cover only a portion of the total charge
• Balance billing is possible

Important: Labs, imaging centers & specialists may have different network statuses
Even if your doctor is in-network, the lab they use, the radiology center they refer to, or the anesthesiologist assisting your procedure may not be.

To avoid unexpected out-of-network bills:

• Ask your provider which lab or facility they use
• Confirm that the location is in-network
• Call us if you want help double-checking

This one step can prevent the most common billing surprises in healthcare.

Your PPO advantages in a nutshell
Your PPO plan gives you:

• Freedom to choose any doctor or specialist
• Lower costs when you stay in-network
• No referrals required
• Nationwide coverage
• Emergency protection anywhere within the United States
• Dedicated support from Realm Health

With the right knowledge, your PPO becomes a powerful tool for affordable, high-quality care.

Are you interested in learning more about Realm Health?

Book an appointment with one of our sales team