Final answer:
Maria, a PPO subscriber, will likely incur higher out-of-pocket expenses when receiving care from an out-of-network provider, including higher deductibles, copayments, or coinsurance, with the risk of additional balance billing charges.
Step-by-step explanation:
If Maria is the subscriber of a Preferred Provider Organization (PPO) and receives care from an out-of-network provider, a likely result is that she will have higher out-of-pocket costs. PPO plans typically have arrangements with a network of providers to offer members lower rates. When care is obtained outside of this network, the PPO does not cover as much of the cost, leaving the subscriber responsible for a larger share of the bill. This could mean paying a higher deductible, higher copayments, or a higher coinsurance rate.
Moreover, the PPO subscriber may have to pay the full cost of the service upfront and then submit a claim to the insurance for reimbursement, which is usually at a reduced rate compared to in-network coverage. It's also important to note that the out-of-network provider is not obligated to accept the PPO's reimbursement as full payment, potentially leaving the patient with additional balance billing charges.