Preferred Provider Organization

Definition

  • A type of managed care health insurance system that gives participants a great deal of flexibility in their health care options. Unlike a health maintenance organization (HMO), a preferred provider organization (also known as a "PPO", "participating provider organization", or "preferred provider option") does not require the client to find a primary care physician, nor does a PPO require the client to acquire a referral from a primary care physician before seeing a specialist.

Synonyms
preferred provider option, participating provider organization

Acronyms
PPO

Related Terms and Acronyms

  • Case Management Definition,
    • A system where medical services and patient treatments are coordinated by a case manager.
  • Concurrent Periods Definition,
    • When a patient requires treatment for more than one ailment at a time, all insurance benefits are paid together.
  • Gatekeeper Definition,
    • In relation to health maintenance organizations, a gatekeeper is a primary care physician that arranges medical care for policyholders.
  • Health Insurance (HI) Acronym,
    • Insurance that covers the costs of medical expenses for insured persons.
  • Health Maintenance Organization (HMO) Acronym, Important,
    • A healthcare plan where insured people receive reasonably priced health insurance through an organization with firm guidelines on the scope of care.
  • Least Expensive Alternative Treatment (LEAT) Acronym,
    • When multiple treatment options exist for the same illness, insurers are only obligated to provide the most cost effective treatment.
  • Medical Specialist Definition,
    • A doctor with training in a specific medical field.
  • Point of Service Plan Definition,
    • A health insurance plan that combines the features of both health maintenance organizations and preferred provider organizations.
  • Primary Care Physician Definition,
    • A doctor who administers or arranges the majority of an individual's health care needs.
  • Successive Periods Definition,
    • When multiple hospital stays are considered as one when the stays are a result of, or are related to, a single medical condition.
  • Universal Healthcare Definition,
    • A system for providing healthcare free to patients at point of use.
  • Usual, Customary and Reasonable Fees Definition,
    • The expected cost of a medical treatment, and what an insurance company is willing to pay.
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