Question

A patient tells a nurse that she is enrolled in a preferred provider organization (PPO) but does not understand what this is. What is the nurse's best explanation of a PPO?

Answer 1

A Preferred Provider Organization (PPO) is a health insurance plan that gives you the flexibility to choose any healthcare provider within its network, but it may lead to higher costs if you go outside the network. It's less restrictive but often comes with higher premiums and copays than an HMO.

Step-by-step explanation:

A Preferred Provider Organization (PPO) is a type of health insurance plan that provides more flexibility when choosing doctors or hospitals. Unlike Health Maintenance Organizations (HMOs), which require you to choose a primary care physician and get referrals to see specialists, a PPO allows you to see any health care provider within the network. However, going outside of this network may result in higher costs. A PPO is less restrictive than an HMO but often comes with higher premiums and out-of-pocket costs such as deductibles and copayments.

Additionally, in a PPO, the organization contracts with medical providers to create a network of preferred providers. You pay less when you use providers from this network. While you have the option to go outside of the network, it will generally cost more, and you may need to pay upfront and submit a claim to the insurance company for reimbursement. The PPO strikes a balance between cost and flexibility, offering a more varied selection of healthcare providers compared to HMOs.