What is a preferred provider organization (PPO)?

A preferred provider organization (PPO) is a type of health insurance plan that provides coverage to members of a plan. PPOs typically have a wider range of providers than other health insurance options, including both in-network and out-of-network providers. In-network providers are those that have entered into an agreement with the PPO to provide care to its members at discounted rates. Out-of-network providers are those that have not entered into an agreement with the PPO, meaning that their care is typically more expensive for members. PPOs often require members to use in-network providers in order to receive the full benefits of their coverage. For example, members may be required to use in-network providers for certain services, such as referrals to specialists or certain procedures, or they may have to meet a deductible or co-pay amount before they can receive a discounted rate. The cost of a PPO plan can vary depending on the plan’s features. However, in California, all health insurance plans, including PPOs, must comply with state law and the regulations of the California Department of Insurance. This means that PPOs must cover certain essential health benefits and provide certain consumer protections, such as allowing members to appeal denied claims.

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What is a preferred provider organization (PPO)?

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