Preferred Provider Organization (PPO) Plans
A Preferred Provider Organization or PPO are a network
of medical providers who offer health and wellness services to
the members of participating health plans for a lower than usual
cost. These doctors and hospitals are generally made available
to members of a health plan by lists issued by their health care
provider indicating that should a member receive health care through
these listed care givers then their expenses will be covered by
full benefits.
Members of a PPO make their own health care choices
as opposed to HMO members, who receive medical services through a primary
care physician . Using a provider
outside of the PPO network is more expensive than choosing one
recommended by your PPO. However, should a PPO member choose a
physician or hospital outside of the network, the health provider
may still cover a percentage of the costs. Athough, in some cases,
no claims made outside of the network will be covered at all.
Be sure to verify that your chosen doctor or hospital
is contracted as a provider with your PPO before undertaking any
procedures or appointments. If your physician is not a network
member, ask for a referral to one who is or for a hospital for
which the provider agrees to pay claims at a ‘preferred’
rate.
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