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PPO
A Preferred Provider Organization is a form of managed care closest
to an indemnity plan. A PPO negotiates arrangements with doctors, hospitals
and other providers who accept lower fees from the insurer for their
services. As a result, your cost-sharing will be lower than if you
go outside the network of providers.
If you go to a doctor within the PPO network, you will pay a copayment
(a set amount you pay for certain services -- say $20 for a doctor
or $10 insurer may reimburse you for 90 percent of the cost if you
go to a provider within the network. If you choose to go a provider
out of the network, the insurer might only reimburse you for, say,
70 percent of the cost.
In addition, with an out-of-network provider, you must pay the difference
between what the provider charges and what the plan pays.
Another characteristic of PPOs is the ability to make self-referrals.
In essence, plan members can refer themselves to doctors of their choice,
including specialists, inside and outside the network. However, as
described above, plan members may incur additional charges for using
out-of-network providers.
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The information contained
in this Web site is provided solely as
a source of general information and resource.
It is subject to change at any time and may vary from state to state.
For a complete description of coverages, always read your insurance policy, including
all endorsements.
Copyright 2008 All Rights Reserved |
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