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 ?
3% over the third quarter of 2003, including the Texas Exclusive Provider Organization (EPO) contract.
Centene Corporation (NYSE:CNC) announced today that the State of Texas issued a statement after the close of market on Friday, May 21, 2004 of its intent to award a contract to the Company's subsidiary, Bankers Reserve Life Insurance Company (d/b/a Superior HealthPlan Network), for the Texas Children's Health Insurance Program (CHIP) Exclusive Provider Organization (EPO).
Note that Anthem Blue Cross next year will convert a majority of its PPOs in California to EPOs - or Exclusive Provider Organizations - which offer no coverage out of network, except in emergencies, Mendelsohn says.