Preferred provider organization
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| Healthcare in the United States |
|---|
In
Overview
A preferred provider organization is a subscription-based medical care arrangement.
History
In 1980, an early PPO was organized in Denver at
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 being largely, or solely, being performed to increase the number of people due. Another near-universal feature is a pre-certification requirement, in which scheduled (non-emergency) hospital admissions, and in some instances, outpatient surgery, must have the prior approval of the insurer and must often undergo "utilization review" in advance.[5]
Comparison to exclusive provider organization (EPO)
A PPO is similar to an
Comparison to health maintenance organization (HMO)
A PPO is similar to a health maintenance organization (HMO) in structure, administration, and operation. Unlike PPOs, however, HMOs often require members to select a primary care physician (PCP), a doctor who acts as a gatekeeper to direct access to non-emergency medical services, and are required to first obtain a referral from their PCP in order to be reimbursed for the cost of medical services inside of their network of designated doctors and hospitals. HMO plans generally have lower cost and lower monthly premiums than PPO plans and HMO members can usually expect to pay less out of pocket to cover medical costs than PPO members.[7]
See also
- Dental plan
- Health maintenance organization
- Independent practice association
- Point of service plan
- Silent PPO
- Single-payer health care
References
- OL 14736792M.
- ^ "Health Harbor - Health Insurance Plan Choices". Archived from the original on 2011-01-11. Retrieved 2011-01-27.
- ^ PMID 6856523.
- ISBN 9780763759117.
- ^ Haas, Marjorie Segel (1991). Preferred Provider Organization. U.S. Department of Labor, Bureau of Labor-Management Relations and Cooperative Programs.
- ^ "Getting Emergency Care". Healthcare.gov. Retrieved 2020-01-19.
- ^ "HMO vs. PPO: Which is right for you?". Humana, Inc.
External links
- healthinsurance.about.com: HMOs vs. PPOs – What Are the Differences Between HMOs and PPOs? (2010)
- Healthcare Network Information
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