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In U.S. health insurance, a preferred provider organization (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 agreed with an insurer or a third-party administrator to provide health care at ...
Preferred provider organizations themselves earn money by charging an access fee to the insurance company for the use of their network (unlike the usual insurance with premiums and corresponding payments paid fully or partially by the insurance provider to the medical doctor).
It combines characteristics of the health maintenance organization (HMO) and the preferred provider organization (PPO). [1] The POS is based on a managed care foundation—lower medical costs in exchange for more limited choice. But POS health insurance does differ from other managed care plans.
In the United States, an exclusive provider organization (EPO) is a hybrid health insurance plan in which a primary care provider is not necessary, but health care providers must be seen within a predetermined network. Out-of-network care is not provided, and visits require pre-authorization.
These prepaid plans burgeoned during the Great Depression as a method for providers to ensure constant and steady revenue. In 1970, the number of HMOs declined to fewer than 40. Paul M. Ellwood Jr. , often called the "father" of the HMO, began having discussions with what is today the U.S. Department of Health and Human Services that led to the ...
As of May 2019, the organization had over 1 million members. The Tufts Health Plan network includes 110 hospitals and 51,000+ health care providers. The health plan offers products for employers, individuals enrolled in Medicare, Medicaid the Massachusetts Health Insurance Exchange, and individuals who are dually eligible for Medicare and ...
Most preferred provider organization plans are open-network (those that are not are often described as exclusive provider organizations, or EPOs), as are point of service (POS) plans. The terms "open panel" and "closed panel" are sometimes used to describe which health care providers in a community have the opportunity to participate in a plan.
IPAs may also offer care providers an information technology platform offering automation and/ or a connection to an Electronic Health Record (EHR) system. Additionally, IPAs structured as risk-bearing entities can give interested care providers the ability to participate in risk contracts even if they don't have the administrative staff to ...