Agent Owner, Gilmore Insurance Services, Marysville, Washington State
It's not so much what it covers, but what it is. A PPO in long form is a Preferred Provider Organization. What that means is the PPO is a network of doctors (all types) belonging to a group (PPO) that discount their services for insureds that use them.
The idea behind PPO is to encourage insureds to use those doctors in the network by offering lower costs and/or better coverage within the network. The PPO and the insurance companies have made pre-arrangements for payment for services. The doctors accept less in payment because the insurance plan design will encourage insureds to use the PPO network. Hope this helps. As far as coverage, a PPO could cover a variety of things in the plan design.
Business Development Officer, T.D. McNeil Insurance Services, Fresno, California
A Preferred Provider Organization (PPO) is a way in which medical care is delivered. If the health plan you are under is administered by a PPO it means that you may take advantage of the services of a selected group of physicians, hospitals etc. The providers who are a part of the PPO have agreed on the charges that they will make to the insurance company. They usually are reduced from the “normal fees.” If you elect to go to a provider who is not a part of your network, the company might honor the claim, however, the payout to the provider might be less than the amount charged. The difference would then be yours to complete. There are other ways that this can be handled but the key is that the group in the PPO delivers medical care at a reduced charge, to you and to the insurance company and that if you go outside the PPO it will cost you more in most cases.
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The idea behind PPO is to encourage insureds to use those doctors in the network by offering lower costs and/or better coverage within the network. The PPO and the insurance companies have made pre-arrangements for payment for services. The doctors accept less in payment because the insurance plan design will encourage insureds to use the PPO network. Hope this helps. As far as coverage, a PPO could cover a variety of things in the plan design.