Introduction

A preferred provider organization or PPO is an independent company that contracts with hospitals, physicians, clinics, chiropractors, chemical dependency facilities, laboratories, medical equipment suppliers, mental health agencies, and a number of other providers to form a network of preferred providers. This network of preferred providers provide their services to individuals at pre-negotiated reduced fees in exchange for this plan’s participation in the network. Although care may be received from a covered provider outside this network, out-of-pocket expenses are lower when care is received from a preferred provider. Preferred providers offer the following important advantages:

• There are no claims to file. Preferred providers bill the Trust Office directly.
• Out-of-pocket expenses are lower when care is received from a preferred provider.
• A $10 office visit copayment for physician office visits is avoided when a preferred provider is used. The $10 office visit copayment applies to nonpreferred providers in Washington State only. This $10 office visit copayment is in addition to the $10 office visit copayment for an office visit billed by a preferred or nonpreferred physician or mental health care provider.
• A $200 inpatient hospital copayment for inpatient admissions is avoided when a preferred provider facility is used. The $200 inpatient hospital copayment applies to nonpreferred hospitals in Washington State only.