What is a PPO?

What is a PPO?

• A. Blend of PPO flexibility and HMO gatekeeper structure
• B. Less restrictive network with discounted fees and minimal UM
• C. Indemnity plan; least managed care
• D. Before care; includes prior authorization

Answer: (B)

A PPO is a network-based plan that combines negotiated discounts with flexibility. You get lower costs by using providers in the network, but you aren’t required to stay strictly in-network; you can see out-of-network providers for a higher out-of-pocket price. There’s typically less gatekeeping than an HMO—you don’t have to obtain a referral to see a specialist—though some services may still require prior authorization. That combination—discounted fees within a broad, less-restrictive network and only light utilization management—best matches the description. The other options describe different plan features (HMO-style gatekeeping, indemnity-style freedom with minimal management, or a focus on preauthorization rather than network structure), which don’t fit a PPO as accurately.

A PPO is a network-based plan that combines negotiated discounts with flexibility. You get lower costs by using providers in the network, but you aren’t required to stay strictly in-network; you can see out-of-network providers for a higher out-of-pocket price. There’s typically less gatekeeping than an HMO—you don’t have to obtain a referral to see a specialist—though some services may still require prior authorization. That combination—discounted fees within a broad, less-restrictive network and only light utilization management—best matches the description. The other options describe different plan features (HMO-style gatekeeping, indemnity-style freedom with minimal management, or a focus on preauthorization rather than network structure), which don’t fit a PPO as accurately.