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.
Farlex Financial Dictionary. © 2012 Farlex, Inc. All Rights Reserved

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.

Dictionary of Financial Terms. Copyright © 2008 Lightbulb Press, Inc. All Rights Reserved.
References in periodicals archive ?
* Another benefit is the elimination of scams such as silent PPOs in which providers submit out-of-network claims to an insurer only to get the claim repriced at an in-network discount.
Clearly, our employees are generally much more comfortable with our PPO plan," Jessee says.
On a $100,000 billed charge, the rental PPO calculates a discount savings of $45,000, which is 45 percent ($45,000 divided by $100,000).
"Better information on physician and hospital quality and performance data from PPOs and other health plans must become more widely available if consumers are expected to make informed choices and seek out quality care in the new medical marketplace," the NCQA argues in its 2004 health care quality report.
The main differences between PPOs and traditional indemnity plans with utilization review were: (a) PPOs used a select panel of providers, and (b) cost sharing was required by PPOs for use of non-network providers.
After investigating these various types of delinquency complaints, PPOs chose to adjust far more cases on their own than to petition juveniles to court for a formal hearing.
The PPO will be mandated to "efficiently, speedily and expeditiously resolve the matters brought to it and it shall have jurisdiction over incidents, conflicts, occurrences, acts or events that have happened within the major airport involving or affecting passenger's rights."
"If there was a PPO member who all their care was provided in the HMO, and that would be their decision, their rate could be cut in half and their care would be unaffected," Peter Berry, chief actuary at CareFirst, said at a rate hearing last year.
The Accountable Care Act turned a spotlight on the employer-pays health care system, and a variety of companies started to publish data outing the PPO industry and the ridiculous "discount" reimbursement model.
furnacalis PPOs and other arthropod PPOs, "prophenoloxidase" was used as a keyword to search the nonredundant database from the National Center for Biotechnology Information (NCBI;