Preferred Provider Organizations
In health insurance in the United States, a preferred provider organization (or “PPO”, sometimes referred to as a participating provider organization or preferred provider option) is a managed care organization of medical doctors, hospitals, and other health care providers who have covenanted with an insurer or a third-party administrator to provide health care at reduced rates to the insurer’s or administrator’s clients. A preferred provider organization is a subscription-based medical care arrangement. A membership allows a substantial discount below the regularly charged rates of the designated professionals partnered with the organization.
Other features of a preferred provider organization generally include utilization review, where representatives of the insurer or administrator review the records of treatments provided to verify that they are appropriate for the condition being treated rather than largely or solely being performed to increase the amount of reimbursement due.
An exclusive provider organization (EPO) is a type of managed care plan that combines features of HMOs and PPOs. It is referred to as exclusive because the employers agree not to contract with any other plan.
In Network Insurances
Aetna Healthplans: PPO, POS , EPO
Beech Street ( Includes CappCare and PPO next)
Blue Shield of California
California Foundation for Medical Care
Cigna PPO, POS, HOM, Open Access HMO, Open Access Plus
Evolution Healthcare Systems
First Health / CCN / Coventry
Fortified Provider Network
Galaxy Health Network
Great West Healthcare
HealthNet PPO, POS, EPO, ASO, HMO WC
Interplan ( HealthSmart)
Pacific Health Alliance
Private Healthcare Systems (PHCS) PPO, Open Access
Sheet Metal Health and Welfare Plan
Out of Network Insurance
Anthem Blue Cross and Blue Cross of California