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PPO Policies

A PPO is a Preferred Provider Organization. A PPO has a contract with certain doctors, hospitals and other health care providers, to provide health care to the insurers’ clients at a reduced rate. The provider gets increased business from the insurance company and the insurance company gets discounted rates for the services provided. Since the insurance company pays a reduced price to the health care providers that savings is usually passed on to the insured through lower premium payments. Preferred Provider Organizations charge an access fee to the insurance company to use their network of doctors and hospitals which is how the PPOs make their money.
A PPO has a utilization review in which representatives of the insurer review the records of provided services for appropriateness prior to paying the provider. They also require pre-certification of any non-emergency hospital admissions and some outpatient surgeries by the utilization review process.