A Preferred Provider Organization or PPO is a network or group of medical providers who offer health services to members of participating health plans at a reduced rate. The information for these medical providers and their facilities is made available to members of a health plan. This is usually done in the form of a pamphlet or book that is updated annually and sent out in bulk to all members. When a member chooses to receive health services through one of the listed preferred provider organizations, their expenses will be covered by their benefits.  

How Is a PPO Different From Other Plans?

This differs from the set up of, for example, an HMO. PPO members choose their health care providers while HMO members must receive all medical services through a primary care physician. However, should a PPO member decide to use a provider outside of the PPO network, their benefits may still cover some of the costs, though their out of pocket expenses will mostly likely rise. Some outside network claims won’t be covered at all.

Double Check Your Choice

Before choosing your doctor or hospital, make sure that you have chosen a PPO contracted provider before undergoing any major procedures or costly tests. If your current physician is not a network member, ask him or her for a referral to one who is or for a facility for which your provider will pay claims at a ‘preferred’ rate.