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.