PPO
Preferred Provider Organization. A health care organization composed of
physicians, hospitals, or other providers which provides health care
services at a reduced fee. A PPO is similar to an HMO, but
care is paid for as it is received instead of in advance in the
form of a scheduled fee. PPOs may also offer more flexibility by
allowing for visits to out-of-network professionals at a greater
expense to the policy holder. Visits within the network require
only the payment of a small fee. There is often a deductible for
out-of-network expenses and a higher co-payment. A policy holder
will have a primary physician within the network who
will handle referrals to specialists that will be covered by the PPO.
After any visit, the policy holder must submit a claim, and will be
reimbursed for the visit minus his/her co-payment.
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