What is a PPO?
A PPO is a form of a managed care program that is closest to an indemnity plan. A PPO has arrangements with doctors, hospitals, and other providers of care who have agreed to accept lower fees from the insurer for their services if you use their network of providers. Unique Features of a PPO: • Low co pays for most wellness/office visits when using a network provider. • You can obtain services either from their network of providers or your personal provider (if not in the network). However, you will pay more if you do not use their network. • No Primary Care Physician is required to coordinate your care. • In-network coinsurance charges and out-of-network charges are reimbursed at Reasonable & Customary (R&C) charges. Reasonable & Customary charges are those charges that fall within the range of fees normally charged for a given procedure by physicians with similar training and experience in a geographic region.
PPO stands for preferred provider organization. A preferred provider organization is an arrangement between a group of doctors or providers and an entity, such as an employer or other group. This arrangement makes it possible for price discounts on services in exchange for a higher volume of patients. A PPO arrangement may be part of a self-funded health care plan. If your coverage is provided under a PPO contract and you do not utilize the preferred providers, you may have substantially higher co-payments.
