Question

You MUST tell your PPO plan clients they will have to pay more when seeking non-emergent eligible services outside of the network.

A) True
B) False
C) Depends on the situation
D) Not specified in the guidelines

Answer 1

Clients must be told they will pay more for non-emergent eligible services outside of their PPO network, reflecting true for the provided statement.

Step-by-step explanation:

The correct answer to the question is A) True. Individuals enrolled in a Preferred Provider Organization (PPO) plan should be informed that they will incur higher costs when seeking non-emergent eligible services outside of the network. PPO plans typically have a network of providers that offer services to members at a lower cost. However, unlike Health Maintenance Organizations (HMOs), PPO plans allow for accessing services outside of their network, but these services come at an increased cost to the plan member. This difference in cost is an essential piece of information that clients need to be aware of to make informed health care decisions.