Contractual arrangements among hospitals, physicians, employers, insurance companies, or third-party administrators to provide health care services to subscribers at a negotiated, often discounted, price.
A type of health care plan that gives patients a choice of using doctors and hospitals in a network and paying a copayment or using physicians and hospitals outside the network and being responsible for a paying an annual deductible and a percent of the bill for the visit.
Network of health care providers having negotiated contracts with a health insurance company for its members to receive services at lower costs. Patients generally maintain the freedom to choose within the network in a PPO arrangement.
A medical or vision insurance plan that entices beneficiaries to use only the facilities and physicians who have contracted with the plan to provide services to beneficiaries by creating a financial disincentive if the beneficiary seeks care outside the plan's panel of providers. Care provided to a patient by a facility or physician that is not contracted by the Preferred Provider Organization is normally a covered benefit of the plan, however at a significantly lower rate than the same care provided by a facility or physician who is a contracted provider. The exception is in some emergency situations or with prior authorization from the plan.
Some combination of hospitals and physicians that agree to provide health care services to a group of people, perhaps under contract with a private insurer. The services may be furnished at discounted rates. Patients may incur expenses for covered services they receive outside the PPO, if the charge from the non-PPO provider exceeds the PPO reimbursement rate.
Managed care entity that consists of hospitals, physicians, and other providers on contract to an insurer, employer, third-party administrator, or other sponsoring group to provide health care services to covered individuals.
A fee-for-service option where you can choose plan-selected providers who have agreements with the plan. When you use a PPO provider, you pay less money out-of-pocket for medical services than when you use a non-PPO provider.
also PPO. With a preferred provider organization, you can see any provider you choose. However, you can take advantage of several benefit features, including lower out-of-pocket costs, when you see a provider who participates in the network. Alliance Select SM is a preferred provider organization.
A network of doctors, hospitals and pharmacies which provide services based on a discounted predetermined fee. Care can be provided by either a network or non-network provider. Unlike an HMO, PPO's do not require the selection of a Primary Care Physician.
A health insurance plan with an established network of healthcare providers. It provides maximum benefit coverage when services are obtained from provider within the network. Reduced benefits generally apply for using health care providers outside of the network.
PPO): PPOs manage medical costs by creating a network of providers who are willing to accept lower reimbursement rates. The providers are often required to meet other requirements, including the insurance company’s utilization review procedures. Patients may choose any health care provider, but they will have to pay additional money if they use a provider who is not part of the PPO network. PPOs are usually associated with traditional insurance companies, not HMOs.
An arrangement under which an insurance company or employer negotiates discounted fees with networks of health-care providers in return for guaranteeing a certain volume of patients. Enrollees in a PPO can elect to receive treatment outside the network but have to pay higher co-payments or deductibles for it.
A type of managed care plan where members obtain services from a network of physicians who have nonexclusive arrangements with the managed care plan. Members also receive some benefit coverage when they obtain services from providers who are not in the plan's network.
Aetna's preferred provider organization (PPO) plan is called Open Choice. Members may choose any health care providers; however, they generally receive a higher benefit level if they choose an Aetna participating provider. Members do not identify a primary care physician to manage their care and can self-refer to providers either in or out-of-network.
A health care delivery system through which an organization of providers contracts to serve health plan enrollees on a fee-for-service basis at discounted fees in return for more patients. Patients may use any provider without a referral, in network or out, but have a financial incentive -- for example, lower coinsurance payments -- to use doctors on the preferred list.
a managed care arrangement that offers enrollees a large choice of primary care and specialty providers from which to choose with fewer utilization restrictions than offered by an HMO. This differs slightly from the typical HMO, in that visits to specialists usually do not require authorization by a Primary Care Physician (PCP). Also, unlike most HMOs, out-of-network usage is allowed by PPOs, though at a higher cost to the member.
Term applied to a variety of direct contractual relationships between hospitals, physicians, insurers, employers, or third-party administrators in which providers negotiate with group purchasers to provide health services for a defined population, and which typically share the following three characteristics: (1) a negotiated system of payment for services that may include discounts form usual charges or ceilings imposed on a charge, per diem, or per discharge basis, (2) financial incentives for individual subscribers (insurers) to use contracting providers usually in the form of reduced co-payments and deductibles, broader coverage of services, or simplified claims processing, and (3) an extensive utilization review program.
A PPO incorporates a network of participating health care providers. However, there is no primary care physician (PCP) to coordinate care, and patients may seek care from any provider in the network without a referral. Network providers accept pre-negotiated fees from insurance carriers as payment for various services, with the patient responsible for either a co-payment, or deductible and coinsurance, depending upon the plan design. If the patient chooses a non-network provider, he or she will assume a larger portion of the cost.
A looser form of Managed Care (weak gatekeeper concept). Establishes a network of providers who agree to supply care at discounted rates. Members pay a small co-payment (no deductible or coinsurance) when utilizing a network provider. PPOs also allow members to utilize non-network providers, but must pay deductibles/coinsurance similar to indemnity plans. There is no requirement to designate a primary care physician and no claim forms when utilizing the network.
A group of hospitals, physicians and other providers who provide health care services to covered patients Members are permitted to seek care outside the PPO network, but benefits may be reduced or out-of-pocket costs may be higher. See Exclusive Provider Organization.
PPOs are managed care organizations that offer certain methods to deliver services, such as networks of providers. Under a PPO benefit plan, covered individuals retain the freedom to choose providers but are given financial incentives (i.e. lower out-of -pocket costs) to use the preferred provider network.
A managed care plan that contracts with networks or panels of providers, which furnish services and are paid according to a negotiated fee schedule. Enrollees are offered a financial incentive to use providers on the preferred list, but may use non-network providers as well.
Ohio Med. A network of hospitals and doctors who have agreed to serve Ohio Med PPO members at a discount. If you use a hospital or provider in the PPO network, you are covered at a higher percent than if you go to a provider outside the network. Employees can use providers who are not part of the PPO but will pay a higher copayment. PPO providers will file claims for you and accept Ohio Med’s allowed amount as payment in full for most covered services. For some benefits and services, you are required to pay deductibles and copayments.
PPO plan (Preferred Provider Organization) combines elements of a Major Medical plan with an HMO. There is a list of Preferred Providers of doctors and hospitals you can choose from, but you are free to choose an out-of-network doctor or hospital. However, if you choose an out-of-network provider, you will probably have to pay an increased percentage of the cost. A typical plan may provide that in-network provider services are provided with an 80/20 co-insurance percentage, while out-of-network provider services would be provided with a 60/40 co-insurance percentage. You usually will have to pay a deductible and a co-insurance payment with a PPO plan
A type of health plan which encourages a member to use in-network providers, but that also provides reduced benefits for covered services if the member chooses an out-of-network provider for care. See health plan product descriptions.
A PPO is a network of doctors and hospitals that contracted with a health plan and have agreed to provide their medical services at rates lower than their standard fees. A PPO offers both in-network and out-of-network benefits.
An insurance benefit in which member hospitals and/or physicians contract with a third-party payer to deliver services for negotiated fees, usually at a reduced rate. Incentives are provided to use contracted providers.
A type of health benefit program in which enrollees receive the highest level of benefits when they obtain services from a physician, hospital, or to her health provider designated by their program as a "preferred provider". Enrollees may receive substantial, though reduced, benefits when they obtain care from a provider of their own choosing who is not designated as a "preferred provider" by their program.
A form of health insurance. A PPO is made up of a group of medical care providers (doctors, hospitals, etc.) who contract with a health insurance company to provide services at an agreed upon discounted price.
In 1991, Colorado enacted a statute that allows insurance companies to offer a "PPO" option. That means for a reduced rate, the consumer agrees to use a specific PPO for medical treatment for injuries suffered in auto accidents. This is an option only. Consumers can save up to 25-percent on the medical portion of their auto insurance premium.
A Preferred Provider Organization (PPO) plan is similar to a Point-of-Service (POS) plan in offering coverage by a network of providers, as well as coverage for out-of-network services. In a PPO plan, you can go to a network specialist for the co-pay of $5, $10 or $15, without obtaining a referral from a Primary Care Physician (PCP). You are not required to choose a PCP in a PPO plan. Pre-certification requirements will still be maintained.
A type of Health Benefit Plan designed to give Members incentives to use health care providers designated as Network Providers, but that also provide reduced Benefits for Covered Services received from Non-Network Providers. PPO plans can also be distinguished from HMO plans by the ability of PPO members to see any specialty physician without referral from a PCP.
nbspWhen you use the doctors and hospitals that are part of the PPO Network, you can have a larger part of your medical bills covered. You can us other doctors, but at a higher cost to you. You do not need a referral from a Primary Care Physician.
A healthcare delivery arrangement which offers insured's access to participating providers at reduced costs. PPOs provide insured's incentives, such as lower deductibles and co-payments, to use providers in the network. Network providers agree to negotiated fees in exchange for their preferred status.
Managed care arrangement consisting of a group of hospitals, physicians and other providers who have contracts with an insurer, employer, third-party administrator or other sponsoring group to provide health care services to covered persons.
A managed care plan that contracts with a select group of participating providers. PPO coverage typically allows members to use non-PPO providers, but higher levels of coinsurance or deductibles may apply to services provided by non-participating providers.
A type of health benefit plan designed to give enrollees incentives to use health care providers designated as “preferred providers”, but that also give substantial coverage for services received from other health care providers. PPO plans can also be distinguished from HMO plans by the ability of PPO members to see any specialty physician without referral from a PCP, although some HMOs with a POS feature may allow this as well.
is a network of providers (hospitals, doctors, labs, etc.) who agree to provide healthcare services to participants at discounted fees. When you receive services with "in-network" providers you pay less. You are also covered if you receive services from "out-of-network" providers but you will pay more.
A type of managed care coverage based on a network of doctors and hospitals that provides care to an enrolled population at a prearranged discounted rate. PPO members usually pay more when they receive care outside the PPO network.
A healthcare benefit arrangement designed to supply services at a lower cost to use in-network healthcare providers (who contract with the PPO at a discount). The PPO also provides coverage for services rendered by healthcare providers who are not part of the PPO network at a higher out-of-pocket cost to the member.
Network of physicians, hospitals and clinics that provide services for pre-negotiated fees. When you need medical care, you can go to a PPO or a non-PPO provider. The insurance company will pay a greater portion of your medical expenses if you go to the PPO.
A type of Medicare Advantage plan in which covered individuals use doctors, hospitals, and providers that belong to the plan network. The PPO may allow beneficiaries to use doctors, hospitals, and providers outside of the network for an additional cost.
Under the FEHB Program, PPOs are only available through enrollment in a Fee-For-Service plan. The PPO is similar to FFS insurance except it uses a network of providers. PPO's give you the choice of using doctors and other providers within the plan's network (the PPO benefit), or using ones outside the plan's network. You don't have to use the PPO, but there are advantages if you do. (Be aware, however, that some of the services provided in a PPO hospital may not be covered by PPO arrangements. Room and board will be covered, but anesthesia and radiology, for instance, will probably be covered under non-PPO benefits.)
A managed-care plan that doctors and hospitals agree to provide discounted rates to. PPOs usually exercise looser management over medical care. For example, they usually don't use primary-care physicians to coordinate patient care. Patients are reimbursed 80 percent to 100 percent for treatment within the PPO versus 50 percent to 70 percent outside of it.
A network of health care provider that have agreed to provide medical services to member's of a health plan at discounted costs. PPO members typically make their own decisions about their health care rather than going through a primary care physician.
A health care benefit plan where medical providers agree to offer their services at a discount. In return, the plan offers members incentives to choose these in-network providers. Coverage for services from other health care providers is available, but at a higher out-of-pocket cost to the member.
A health care plan that contracts with select providers who agree to offer health care services to enrollees at contractually set reimbursement levels. In return, these providers receive patients and prompt payment from the PPO. PPOs allow enrollees to receive health care services outside the PPO network, usually in exchange for a higher copayment or coinsurance amount. Enrollees receive benefit incentives if PPO providers are used.
A preferred group of dentists who have contracted to provide dental services at a discounted rate in return for access to the insurance plan's subscribers. Can be known as contract dental organization (CDO).
A formally organized entity of hospital and outpatient providers that agrees to accept discounted fees for treating enrollees of a managed care plan in return for prompt payment and an expectation of a larger volume of patients. Enrollees may choose non-PPO providers but usually pay a higher portion of the costs than for PPO providers.
A network of providers which allows the enrollee the option of pursuing care outside of the network, for higher fees. All physicians are paid on a fee-for-service basis. Network physicians are paid reduced fees in exchange for their preferred status.
( Related information) A health plan in which consumers may use any health care provider on a fee-for-service basis. Consumers will be charged more for visiting providers outside of the PPO network than for visiting providers in the network (American Association of Preferred Provider Organizations).
A PPO allows patients to see a doctor from the planâ€™s network of physicians for a small copayment fee. Patients who choose to see a doctor out of the network must pay the balance between the PPOâ€™s scheduled fee and the billed amount.
A network or panel of physicians and hospitals that agrees to discount its normal fees in exchange for a high volume of patients. The insured individual can choose from among the physicians on the panel.
Hospital, physician, or other provider of health care which an insurer recommends to an insured. A PPO allows insurance companies to negotiate directly with hospitals and physicians for health services at a lower price than would be normally charged.
A health care plan offering either comprehensive or a limited range of health care services performed by providers selected by the plan. It allows members to use providers outside the network but enrollees may pay for a portion.
A health benefits plan that lets members choose any provider without designating a primary care physician, but offers financial incentives to members who choose a "preferred" or in-network doctor or hospital.
A type of plan in which physicians, hospitals, and other providers agree to discount rates for an insurance company. These providers are part of the PPO´s network. Insurance contracts with PPO provisions reimburse at a higher percentage if you use providers in the network. If you go to providers outside the PPO´s network, you will have to pay more for your care.
A health plan that requires deductible and coinsurance for services rendered. You may choose either in-network or out-of-network providers. When you use the doctors and hospitals that are part of the PPO, you can have a larger part of your medical bills covered. You can use other doctors, but at a higher cost.
Most Carriers have entered into agreements with organizations of doctors and other health care professionals called PPOs in order to establish fees and rates that are lower than average for their health insurance policy holders. Under a PPO health insurance policy, the health insurance policy holder will be charged a lower rate for treatment from a member of the PPO. However, any health care received from a provider outside of the designated PPO will either not be covered or will be covered at a lower rate from the carrier making the cost for that treatment or service to the health insurance policy holder greater.
A formal agreement between a purchaser of a dental benefit program and a defined group of dentists for the delivery of dental services to a specific patient population, as an adjunct to a traditional plan, using discount fees for cost savings.
A network of doctors, hospitals and other healthcare providers who provide healthcare services to plan members. Members have the flexibility to choose a network provider or to select any provider outside the network, each time they need healthcare. Members save money when they use in-network providers.
An arrangement whereby a payer contracts with a group of health care providers (for example, doctors, nurses, lab people) to provide services at lower than usual cost. In return, the insurance company promises to pay these people quickly and make sure they get a certain number of patients.
a health care delivery arrangement which offers insureds access to participating providers at reduced costs. PPOs provide insureds incentives, such as lower deductibles and copayments, to use providers in the network. Network providers agree to negotiated fees in exchange for their preferred provider status.
Some combination of hospitals and physicians that agrees to render particular services to a group of people, perhaps under contract with a private insurer. The services may be furnished at discounted rates and the insured population may incur out-of-pocket expenses for covered services received outside the PPO if the outside charge exceeds the PPO payment rate.
A health care delivery system that contracts with providers of medical care to provide services at discounted fees to members. Members may seek care form non-participating providers but generally are financially penalized for doing so by the loss of the discount and subjection to copayments and deductibles.
A group of hospitals and physicians that makes a contract with employers, insurers, and other organizations to provide comprehensive health care services at discounted fees for individuals who are members of the PPO.
a managed care organization that contracts with select providers of medical care thereafter referring to as preferred providers. Covered individuals are encouraged or required to utilize the preferred providers in order to gain better benefits, higher levels of coverage or any coverage at all. PPO's seek to managed care to assure the most efficient outcomes. Providers may be, but are not necessarily, paid on a discount fee-for-service basis.
A combination of traditional fee-for service and HMO health plans. This is an organization of providers who have agreed to provide medical services for a discounted rate. You can see any doctor in the PPO network without requiring any special approval, and you usually do not need to choose a primary care physician. You may also seek care outside the PPO network, but you will be incurring higher out-of-pocket expenses.
Having a PPO means that you can see the provider of your choice. Providers may be "in-network" with the PPO or "out-of-network". Providers who join a network offer their services to the members at a discounted rate. If your provider is not contracted with the plan, your PPO may still provide coverage, but often at a reduced benefit rate.
FFS Plans and many HDHPs use PPOs which are a network of providers. PPOs give you the choice of using doctors and other providers in the network or using non-network providers. You don’t have to use the PPO, but there are advantages if you do. (Be aware, however, that some of the services provided in a PPO hospital may not be covered by PPO arrangements. Room and board will be covered, but anesthesia and radiology, for instance, may be covered under non-PPO benefits.) Note that some FFS plans may offer an enrollment option that is "PPO-only." You must use network providers to receive benefits from a PPO-only plan.
A type of managed care in which the providers provide services at pre-arranged prices on a fee-for-service basis rather than on a pre-paid basis. If the insured uses one of these, they usually have no or low deductible or copayment.
a health plan in which a member's health care services are completely paid for if obtained from one of a select group of 'preferred' providers chosen by the plan, or partially paid if obtained from an unaffiliated provider.
A managed health care plan that arranges with health care providers for the delivery of health care at a discounted cost and provides incentives for PPO members to use the health care providers who have contracted with the PPO, but that also provides some coverage for services rendered by health care providers who are not part of the PPO network. See also managed health care plans and preferred provider arrangement (PPA).
A managed care organization that allows members to seek care from in-network physicians without having to designate a primary care physician. As a result, members are not required to obtain a referral before visiting another physician or specialist within the network. Members are allowed to see physicians who are not part of the network but at greater cost.
A network of doctors and hospitals that provides care at a lower cost than through traditional insurance. PPO members get better benefits (more coverage) when they use the PPO's network of health care providers. They pay higher out-of-pocket costs when they choose to get care outside the PPO network.
An organization of hospitals and physicans who provide, for a set fee, services to insurance company clients. These providers are listed as preferred and the insured may select from any number of hospitals and physicians without being limited as with an HMO. Coverage is 100%, with a minimal copayment for each office visit or hospital stay. Contrast with Health Maintenance Organization.
A group of health care providers that contracts with employers, insurance companies, union trust funds, third-party administrators, or others to provide medical care services at a reduced fee. PPOs can be organized by the providers themselves or by organizations such as insurance companies, the Blues, or groups of employers.
A group of hospitals and physicians that contract on a fee-for-service basis with employers, insurance companies or other third party administrators to provide comprehensive medical service. Providers' exchange discounted services for increased volume.
a contractual arrangement between independent providers and an employer or insurance company to deliver health services to a defined population at established fees. The PPO contains a panel of physicians and health care institutions that are the preferred providers. Health care services are delivered on a fee-for-service basis at established rates, usually discounted from the physician's usual and customary rates. PPO members pay a larger coinsurance amount for using non-preferred providers.
A type of Health Benefit Plan designed to give Members incentives to use health care providers designated as "preferred providers," but that also give substantial coverage for services received from other health care providers. A PPO that requires the use of a PCP is sometimes referred to as a "Point of Service" (POS) plan.
An arrangement whereby an insurer or managing entity contracts with a group of health care providers who furnish services at lower than usual fees in return for prompt payment and a certain volume of patients.
A combination of traditional fee-for-service and HMO health plans. There is a network of providers that have agreed to provide services for a discounted rate. When you use the doctors and hospitals that are part of the established PPO network, a large part of your medical bills are covered. You can use other doctors outside the network, but at a higher cost.
PPOs generally provide "in-network" and "out-of-network" benefits and do not require a Primary Care Physician referral to see a specialist. The amount the member must pay out of pocket is less when using an "in-network" provider.
A type of insurance product in which beneficiaries receive a high level of benefits by utilizing a network of health care providers. The health care providers in the network agree to accept discounted rates in return for an anticipated or contractual higher volume of patients.
Another type of managed care plan. Members have a choice of utilizing healthcare providers in the PPO network, or hospitals, doctors and other healthcare professionals outside the plan for an additional cost. Beginning in 2003, PPO plans are available to Medicare beneficiaries in 23 states.
A managed care program that combines the freedom of fee-for-service with cost-management features by encouraging patients to use participating dentists. These dentists are selected either for their moderate fees or because they have agreed to accept a reduced fee schedule for PPO patients. Patients may choose any dentist, but will receive the highest level of benefits by selecting a PPO dentist. [Delta Dental's PPO program is known as DELTA PREFERRED OPTION.
A health care benefit arrangement designed to supply services at a discounted cost by providing incentives for members to use designated health care providers (who contract with the PPO at a discount), but which also provides coverage for services rendered by health care providers who are not part of the PPO network.
A group of health care providers (physicians, hospitals, and other providers) located within a specific geographical area that have contracted with an entity (a physicians' group or hospital, for example) to provide health care services.
A managed care plan that provides health care to its members on a prepaid basis. In a PPO, you can get care from the doctors and hospitals in the plan's network or pay more to go to doctors and hospitals outside the network. Many PPOs don't require you to choose a primary care doctor or get a referral to see a specialist.
A network of health care provider that have agreed to provide medical services to members of a health plan at discounted costs. PPO members typically have greater flexibility in selecting healthcare providers.
A PPO is a form of managed care 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. As a result, your cost sharing should be lower than if you go outside the network. In addition to the PPO doctors making referrals, plan members can refer themselves to other doctors, including ones outside the plan. If you go to a doctor within the PPO network, you will pay a co-payment (a set amount you pay for certain services—say $20 for a doctor or $15 for a prescription). Your co-insurance will be based on lower charges for PPO members. If you choose to go outside the network, you will have to meet the deductible and pay co-insurance based on higher charges. In addition, you may have to pay the difference between what the provider charges and what the plan will pay.
Health] a group of health care providers (which may include physicians and hospitals) that contracts with a plan administrator or sponsor to provide certain health care services, usually at a discounted rate (identical to ASOP No. 16]; distinguished from EXCLUSIVE PROVIDER ORGANIZATION, HEALTH MAINTENANCE ORGANIZATION
A network of health care providers with which a health insurer has negotiated contracts for its insured population to receive health services at discounted costs. Health care decisions generally remain with the patient as he or she selects providers and determines his or her own need for services. Patients have financial incentives to select providers within the PPO network.
The UT Select PPO plan is administered by Blue Cross Blue Shield of Texas. Members have the option to use network or non-network providers. To receive network benefits, members must utilize Blue Cross Blue Shield PPO providers. An office visit is a $25 co-payment with a family care physician and a $30 co-payment with a specialist. For other covered services, there is a $250 deductible before the plan pays 80% of all services considered reasonable and customary and the member pays 20%. The maximum amount payable by the member is $1,750 for reasonable and customary charges per plan year. Network providers may not bill members for any charges above those considered reasonable and customary.
A program in which contracts are established with providers of medical care. Usually the benefit contract provides significantly better benefits (few copayments) for services received from preferred providers, thus encouraging covered persons to use these providers. Covered persons generally are allowed benefits for non-participating providers services, usually on an indemnity basis with significant copayments. A PPO arrangement can be insured or self-funded. Providers may be, but are not necessarily, paid on a discounted fee-for-service.
An organization whose members pay a monthly flat fee and select a primary caregiver from a specific list of participating physicians. Members may obtain services from a non-participating physician, but will pay a larger co-payment. PPOs contract with participating physicians for lower rates since payment is made on a Fee-For-Service basis, rather than Capitation.
a program that establishes contracts with providers of medical care. Providers under such contracts are referred to as preferred providers. Usually, the benefit contract provides significantly better benefits and lower member cost for services received from preferred providers, thus encouraging covered persons to use these providers. Covered persons generally are allowed benefits for non-participating providers' services, usually on an indemnity basis. A PPO arrangement can be insured or self-funded. Providers may be, but are not necessarily, paid on a discounted fee-for-service basis
In health insurance, a preferred provider organization (or "PPO", sometimes referred to as a participating provider organization) is a managed care organization of medical doctors, hospitals, and other health care providers who have covenanted with an insurer or a third-party administrator to provide health care at reduced rates to the insurer's or administrator's clients.