Question

During an interview with a client planning elective surgery, the client asks the nurse, "What is the advantage of having a preferred provider organization insurance plan?" Which response is best for the nurse to provide?

A) Long-term relationships with healthcare providers are more likely.
B) There are fewer healthcare providers to choose from than in an HMO plan.
C) Insurance coverage of employees is less expensive to employers.
D) An individual can become a member of a PPO without belonging to a group.

Answer 1

The main advantage of a preferred provider organization (PPO) plan is the greater flexibility in choosing healthcare providers and the possibility of negotiated lower rates, which can lead to reduced costs for both insured individuals and the insurance company. PPOs also often do not require primary care physician selections or specialist referrals.

Step-by-step explanation:

During an interview with a client planning elective surgery, when asked about the advantages of having a preferred provider organization (PPO) insurance plan, the best response a nurse can provide is the ability of these plans to offer a broader selection of healthcare providers compared to an HMO (Health Maintenance Organization). PPOs typically allow patients to see healthcare providers outside of their network, although at a higher out-of-pocket cost. This option increases the flexibility and choice for individuals when seeking medical care.

Furthermore, PPOs negotiate with healthcare providers for lower rates due to the volume of clients they represent. This is beneficial for consumers, as they have access to care at negotiated lower rates, and advantageous for the insurance company, as it saves money on claims. Moreover, there's often no need to choose a primary care physician or get referrals to see specialists, providing a more direct path to various medical services.