Preferred Provider Organization

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Preferred Provider Organization

A health insurance plan in which the policyholder receives a discount from the full price if he/she receives medical services from a participating doctor, hospital, or other medical organization. In many ways, a PPO operates like other insurance policies: the policyholder pays a premium each month and, in exchange, the insurance company pays for the cost of medical care, after a deductible and co-insurance. What distinguishes a PPO from other policies is the fact that a group of doctors or hospitals may negotiate a discounted rate with the insurance company. This provides the policyholder with an incentive to receive care from this group. However, medicals services provided by organizations outside the group are also covered. See also: Health maintenance organization.

Preferred Provider Organization (PPO).

A preferred provider organization (PPO) is a network of doctors and other healthcare providers that offers discounted care to members of a sponsoring organization, usually an employer or union.

You may also arrange private insurance coverage through a PPO.

If you're insured through a PPO, you make a copayment for each visit to a healthcare provider, though certain diagnostic tests may not require copayment.

You typically have the option to go to a doctor or other provider outside the network, but you pay a larger percentage of the cost, called coinsurance, than if you used a network doctor.

References in periodicals archive ?
We're looking forward to the opportunity to serve the needs of Anthem Blue Cross Prudent Buyer members through our new ACO structure.
And, as a national TPA, we can combine the California Prudent Buyer Plan PPO with other leading regional and national networks to seamlessly cover employees located outside California as well.
The BC Life and Health (BCLH) plan will be known as the Prudent Buyer HCO.
The new contract takes effect April 16, 2001, and will allow Blue Cross Prudent Buyer and CaliforniaCare members to continue to access all Adventist Health's California hospital medical services without interruption.
The lawsuit, related to retroactive fee reductions in 1993, 1994, and 1995 for possibly 30,000 physicians participating in Blue Cross's Prudent Buyer Plan, also charges Blue Cross with breach of the implied covenant of good faith and fair dealing.
The new rates will take effect April 16, 2001, and will allow Blue Cross Prudent Buyer and CaliforniaCare members to continue to access the hospital's medical services without interruption.
PHILADELPHIA, May 11 /PRNewswire/ -- The Antitrust Division of the United States Justice Department "has decided to close its investigation of Independence Blue Cross's Prudent Buyer Policy," according to Justice Department Attorney Steven Kramer.
Ford noted that the multiyear agreement applies to Blue Cross of California's Prudent Buyer PPO, Blue Cross HMO and Blue Cross Senior Secure members.
Following the free screenings, available by appointment only through 800-274-WELL, Check-Up centers will accommodate Blue Cross of California's Prudent Buyer Plan members on a pre-determined schedule of approximately eight times yearly.
The new contract is applicable to all Blue Cross HMO members, Prudent Buyer PPO members, Medicare SeniorSecure and Medicare supplemental covered lives.
Things are a little quiet due to the current economy but a prudent buyer will recognize that this valuable business is Opportunity Knocking.
Brown noted that the multi-year agreement applies to Blue Cross of California's Prudent Buyer PPO, CaliforniaCare HMO and Medicare secondary and Medicare supplement members.