Florida Health Insurance Definitions

Florida Health Insurance Terms:
"Preferred Provider Organization"

Define: "Preferred Provider Organization"

This is a type of "managed care plan" which contracts with independent providers (hospitals, physicians, ancillary providers) for negotiated discounted fees for services provided to covered persons. The covered persons usually have free choice of providers but have a financial incentive (e.g., reduced copayments, lower deductibles) to use participating providers.

OTHER USES -- "PPO. A health care organization composed of physicians, hospitals, or other providers which provides health care services at a reduced fee. A PPO is similar to an HMO, but care is paid for as it is received instead of in advance in the form of a scheduled fee. PPOs may also offer more flexibility by allowing for visits to out-of-network professionals at a greater expense to the policy holder. Visits within the network require only the payment of a small fee. There is often a deductible for out-of-network expenses and a higher co-payment. A policy holder will have a primary physician within the network who will handle referrals to specialists that will be covered by the PPO. After any visit, the policy holder must submit a claim, and will be reimbursed for the visit minus his/her co-payment. "

More Examples of Preferred Provider Organization:

A health benefit plan with contracts between the sponsor and health care providers to treat plan members. A PPO can also be a group of health care providers who contract with an insurer to treat policyholders according to a predetermined fee schedule. PPOs can range from one hospital and its practicing physicians that contract with a large employer to a national network of physicians, hospitals and labs that contract with insurers or employer groups. PPO contracts typically provide discounts from standard fees, incentives for plan enrollees to use the contracting providers, and other managed care cost containment methods.

Further details - Preferred Provider Organization:: Search BeechST


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