What best defines a PPO?

What best defines a PPO?

• A. A plan where all services are paid fully out-of-pocket.
• B. A plan with a single primary care physician only.
• C. A plan that reimburses at 100% even for out-of-network care.
• D. A network of providers who agree to prearranged costs for subscribers.

Answer: (D)

PPOs are health plans that rely on a network of doctors and facilities that have contracted with the insurer to set discounted, prearranged rates for members. This means you save money by using in-network providers because their fees are negotiated in advance. You can still see providers outside the network, but you’ll typically pay higher costs and the plan may cover a smaller portion of the bill since those rates aren’t prearranged. The idea of providers agreeing to prearranged costs for subscribers is the defining feature of a PPO. This differs from plans that require picking a single primary care physician (more typical of HMOs) and from plans that promise full reimbursement even for out-of-network care (not how standard PPOs work).

PPOs are health plans that rely on a network of doctors and facilities that have contracted with the insurer to set discounted, prearranged rates for members. This means you save money by using in-network providers because their fees are negotiated in advance. You can still see providers outside the network, but you’ll typically pay higher costs and the plan may cover a smaller portion of the bill since those rates aren’t prearranged. The idea of providers agreeing to prearranged costs for subscribers is the defining feature of a PPO. This differs from plans that require picking a single primary care physician (more typical of HMOs) and from plans that promise full reimbursement even for out-of-network care (not how standard PPOs work).