Preferred Provider Organization

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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.
http://en.wikipedia.org/w/index.php?title=Health_carehttp://en.wikipedia.org/w/index.php?title=Covenant_%28law%29http://en.wikipedia.org/w/index.php?title=Health_professionhttp://en.wikipedia.org/w/index.php?title=Hospitalhttp://en.wikipedia.org/w/index.php?title=Medical_doctorhttp://en.wikipedia.org/w/index.php?title=Medical_doctorhttp://en.wikipedia.org/w/index.php?title=Managed_carehttp://en.wikipedia.org/w/index.php?title=United_Stateshttp://en.wikipedia.org/w/index.php?title=Health_insurancehttp://en.wikipedia.org/w/index.php?title=Healthy_San_Franciscohttp://en.wikipedia.org/w/index.php?title=Healthy_Howardhttp://en.wikipedia.org/w/index.php?title=Fair_Share_Health_Care_Acthttp://en.wikipedia.org/w/index.php?title=Mainehttp://en.wikipedia.org/w/index.php?title=Dirigo_Healthhttp://en.wikipedia.org/w/index.php?title=Connecticuthttp://en.wikipedia.org/w/index.php?title=SustiNethttp://en.wikipedia.org/w/index.php?title=Vermont_health_care_reformhttp://en.wikipedia.org/w/index.php?title=Oregon_Health_Planhttp://en.wikipedia.org/w/index.php?title=Massachusetts_health_care_reformhttp://en.wikipedia.org/w/index.php?title=Patient_Protection_and_Affordable_Care_Acthttp://en.wikipedia.org/w/index.php?title=Health_Information_Technology_for_Economic_and_Clinical_Health_Acthttp://en.wikipedia.org/w/index.php?title=Patient_Safety_and_Quality_Improvement_Acthttp://en.wikipedia.org/w/index.php?title=Medicare_Prescription_Drug%2C_Improvement%2C_and_Modernization_Acthttp://en.wikipedia.org/w/index.php?title=Health_Insurance_Portability_and_Accountability_Acthttp://en.wikipedia.org/w/index.php?title=Emergency_Medical_Treatment_and_Active_Labor_Acthttp://en.wikipedia.org/w/index.php?title=Medical_underwritinghttp://en.wikipedia.org/w/index.php?title=Health_maintenance_organizationhttp://en.wikipedia.org/w/index.php?title=Managed_carehttp://en.wikipedia.org/w/index.php?title=Medical_savings_account_%28United_States%29http://en.wikipedia.org/w/index.php?title=High-deductible_health_planhttp://en.wikipedia.org/w/index.php?title=Health_savings_accounthttp://en.wikipedia.org/w/index.php?title=Health_Reimbursement_Accounthttp://en.wikipedia.org/w/index.php?title=Flexible_spending_accounthttp://en.wikipedia.org/w/index.php?title=Consumer-driven_health_carehttp://en.wikipedia.org/w/index.php?title=Health_insurance_in_the_United_Stateshttp://en.wikipedia.org/w/index.php?title=Program_of_All-Inclusive_Care_for_the_Elderlyhttp://en.wikipedia.org/w/index.php?title=State_Children%27s_Health_Insurance_Programhttp://en.wikipedia.org/w/index.php?title=Medicaidhttp://en.wikipedia.org/w/index.php?title=Medicare_%28United_States%29http://en.wikipedia.org/w/index.php?title=TRICAREhttp://en.wikipedia.org/w/index.php?title=Military_Health_Systemhttp://en.wikipedia.org/w/index.php?title=Veterans_Health_Administrationhttp://en.wikipedia.org/w/index.php?title=Indian_Health_Servicehttp://en.wikipedia.org/w/index.php?title=Federal_Employees_Health_Benefits_Programhttp://en.wikipedia.org/w/index.php?title=Health_care_in_the_United_States


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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
http://healthharbor.com/health-insurance-101/plan-typeshttp://openlibrary.org/books/OL14736792M/An_introduction_to_preferred_provider_organizations_(PPOs)http://en.wikipedia.org/w/index.php?title=Subscription


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Article Sources and Contributors 3

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