Introduction
A
preferred provider organization or PPO is an independent company that contracts
with hospitals, physicians, clinics, chiropractors, chemical dependency
facilities, laboratories, optometrists, medical equipment suppliers, mental
health agencies, and a number of other provider types. This network of providers
provides you and your dependents with efficient, cost-effective care in exchange
for the plan’s participation in the network.
Although you may receive care
from any licensed provider covered by this plan, your benefits are enhanced if
you receive care from a preferred provider. Preferred providers offer the
following important advantages:
- Each
individual is responsible for the first $10 of covered expenses when a physician or mental health care provider bills an office visit. Each individual is
also responsible for an additional $10 of covered expenses when a nonprefered
provider bills an office visit (for care received in Washington State only).
This additional $10 is waived when a preferred provider is used.
- Each
individual is responsible for the first $200 of covered expenses for every
inpatient hospital admission at a nonpreferred provider facility (for care
received in Washington State only). This $200
copayment is waived
when a preferred facility is used.
- Most
preferred providers discount their services which means less out-of-pocket
expenses. Failure to use a preferred provider may result in a reduction of
benefits.
- A
direct billing and
payment system between this plan and the provider or facility eliminates most
paperwork.
|
|
|
