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Preferred Provider Organization 1 Preferred Provider Organization Preferred provider organization 1 Preferred provider organization Health care in the United States Government Health Programs • Federal Employees Health Benefits Program • Indian Health Service • Veterans Health Administration • Military Health System / TRICARE • Medicare • Medicaid / State Health Insurance Assistance Program (SHIP) • State Children's Health Insurance Program (CHIP) • Program of All-Inclusive Care for the Elderly (PACE) • Prescription Assistance (SPAP) Private health coverage • Health insurance in the United States • Consumer-driven health care • Flexible spending account (FSA) • Health Reimbursement Account • Health savings account • High-deductible health plan (HDHP) • Medical savings account (MSA) • Private Fee-For-Service (PFFS) • Managed care (CCP) • Health maintenance organization (HMO) • Preferred provider organization (PPO) • Medical underwriting Health care reform law • Emergency Medical Treatment and Active Labor Act (1986) • Health Insurance Portability and Accountability Act (1996) • Medicare Prescription Drug, Improvement, and Modernization Act (2003) • Patient Safety and Quality Improvement Act (2005) • Health Information Technology for Economic and Clinical Health Act (2009) • Patient Protection and Affordable Care Act (2010) State level reform • Massachusetts health care reform • Oregon Health Plan • Vermont health care reform • SustiNet (Connecticut) • Dirigo Health (Maine) Municipal health coverage • Fair Share Health Care Act (Maryland) • Healthy Howard (Howard Co., Maryland) • Healthy San Francisco In health insurance in the United States, a preferred provider organization (or PPO, sometimes referred to as a participating provider organization or preferred provider option) is a managed care organization of medical doctors, hospitals, and other health care providers who have covenanted with an insurer or a third-party administrator to provide health care at reduced rates to the insurer's or administrator's clients. Preferred provider organization 2 Overview A preferred provider organization[1] is a subscription-based medical care arrangement. A membership allows a substantial discount below the regularly charged rates of the designated professionals partnered with the organization. Preferred provider organizations themselves earn money by charging an access fee to the insurance company for the use of their network (unlike the usual insurance with premiums and corresponding payments paid either in full or partially by the insurance provider to the medical doctor). They negotiate with providers to set fee schedules, and handle disputes between insurers and providers. PPOs can also contract with one another to strengthen their position in certain geographic areas without forming new relationships directly with providers. This will be mutually beneficial in theory, as the insurer will be billed at a reduced rate when its insureds utilize the services of the "preferred" provider and the provider will see an increase in its business as almost all and or insureds in the organization will use only providers who are members. PPOs have gained popularity in the past decade because, although they tend to have slightly higher premiums than HMOs and other more restrictive plans, they offer patients more flexibility overall.[2] PPO Other features of a preferred provider organization generally include utilization review, where representatives of the insurer or administrator review the records of treatments provided to verify that they are appropriate for the condition being treated rather than largely or solely being performed to increase the amount of reimbursement due. Another near-universal feature is a pre-certification requirement, in which scheduled (non-emergency) hospital admissions and, in some instances outpatient surgery as well, must have prior approval of the insurer and often undergo "utilization review" in advance. EPO An exclusive provider organization (EPO) is a type of managed care plan that combines features of HMOs and PPOs. It is referred to as exclusive because the employers agree not to contract with any other plan. References [1] http:/ / openlibrary. org/ books/ OL14736792M/ An_introduction_to_preferred_provider_organizations_(PPOs) [2] http:/ / healthharbor. com/ health-insurance-101/ plan-types Article Sources and Contributors 3 Article Sources and Contributors Preferred provider organization Source: http://en.wikipedia.org/w/index.php?oldid=527398071 Contributors: -Majestic-, 121a0012, AED, Amakuru, Animum, Bennydigital, Bigcheesebebbs, Biosthmors, Briaboru, Cinagua, CliffC, Cmcnicoll, DRosenbach, Darius Sinclair, Equendil, Esrever, Everyking, Firefeather, Fredcastello, Funandtrvl, Gorwell, Gracenotes, Grayshi, Gunton82, Harlock jds, Honeyue, ImperfectlyInformed, Iridescent, Jafeluv, Jason Quinn, L Kensington, Malik Shabazz, Myownworst, Nepenthes, Orzechol, PVSpud, Pagrashtak, Paulmcdonald, Prowler08, Quantpole, Radagast83, RadioFan, Rlquall, Sebas100003, Seidenstud, Soliloquial, Sprewell, Srleffler, Thisisborin9, Timwaw, Vegaswikian, Wayward, Widr, Willking1979, Xanzzibar, Xyz or die, 90 anonymous edits License Creative Commons Attribution-Share Alike 3.0 Unported //creativecommons.org/licenses/by-sa/3.0/.
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