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Health Insurance preferred provider organizations

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A preferred health insurance provider organization (or "PPO") is a managed care organization of medical doctors, hospitals, and other health care providers who have covenanted with a health insurer or a third-party administrator to provide reduced rates to the insurer's or administrator's health insurance clients.

Preferred health insurance provider organization will provide the insured members of the group a substantial discount below their normal rates. This is mutually beneficial as the health insurance insurer is billed at the reduced rate when its insured use the services of the "preferred" provider, the provider benefits because almost all insureds use only providers who are members. Those taking out this type of health insurance should benefit, as lower costs to the insurer will likely result in lower rates of premium increase.

In health maintenance organizations, the policy holders do not utilize members of the organization as their health care providers and therefore receive little or no benefit. PPO members are reimbursed for utilization of non-preferred providers but at a rate which can include co-payments, higher deductibles, and lower reimbursement percentages.

Health insurance treatment reviews are also common where the treatment provided can be scrutinized ensuring appropriate care has been provided rather than with the intention to increase reimbursement, many providers resent this and see it as second guessing their judgement.

Health Insurance Pre-certification is a requirement in which scheduled (non-emergency) hospital admissions and outpatient surgery in some cases must have prior approval of the insurer.

Medical health insurance inflation in the U.S. saw a reduction in the 1990's and many credited this to PPO's, however the situation has changed somewhat as most providers are now members of most of the major preferred provider organizations sponsored by major insurers and administrators. This has resulted in the competitive advantages outlined being virtually reduced or almost entirely eliminated and consequently medical inflation in the U.S. is again advancing ahead of general inflation. This article has been written by http://www.health-insurance-matters.info For more information on health insurance, visit our web site http://www.health-insurance-matters.info This article is not a substitute for professional advice. Please feel free to use this article in your newsletter or on your web site, the resource box must be included. If you use this article, please send a brief message to let me know where it appeared: mailto:him@t4star.com Thank you.

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Additional Reading


Student Health Insurance
Health insurance is increasingly important. With the rate at which medical expenses have continued to rise over previous years, and the reductions in government funded health care programs, being without health insurance is less an option...

Health Insurance for Seniors on the Web
Health Insurance For Seniors On The Net When a good friend of mine inquired where he could obtain information about medical insurance for his out-of-state, elderly mother, I told him to try the Internet. He reported back to me about a week later,...

Short Term Health Insurance
If you are between jobs or are awaiting another health insurance policy to come into effect you may find that you have a gap in your health insurance coverage. This period is a high risk as you are effectively uninsured when it comes to health...



 

 

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