Institute:Office of National Coordinator (ONC) Workforce Training Curriculum
Component:Introduction to Health Care and Public Health in the U.S.
Unit:Financing Health Care - Part 1
Lecture:Payors in the U.S. Health Care System
Slide content:Preferred Provider Organization (PPO) Any provider In-network providers Lower deductibles, copayments, and coinsurance Out-of-network providers Higher deductibles and coinsurance for the patient EPO Must use in-network providers No reimbursement for out of network provider services No gatekeeper for either a PPO or EPO 18
Slide notes:In a PPO, reimbursement is provided using a fee-for-service methodology where patients receive discounts and savings for using in-network providers. PPOs feature lower deductibles, copayments, and coinsurance. In a PPO, a patient is free to seek care from any provider they choose and will still receive some reimbursement. A variation of the PPO is the exclusive provider organization, or EPO. It is similar to a PPO, but care must be obtained through in-network providers only. Health care services supplied by providers outside the network are not reimbursable through the EPO. In both the PPO and EPO plans, no gatekeeper controls access to medical services and individuals may seek care from any provider. 18