Under a PPO, how is out-of-network care typically paid relative to in-network care?

Under a PPO, how is out-of-network care typically paid relative to in-network care?

• A. Out-of-network care is covered at the same rate as in-network care.
• B. Out-of-network care is not covered at all.
• C. Out-of-network care may be covered, but at a higher cost.
• D. Out-of-network care is always fully reimbursed.

Answer: (C)

In a PPO, you can go to out-of-network providers, but you pay more for that choice. The plan usually covers out-of-network services, but at a lower reimbursement rate and with higher patient cost sharing (higher deductible, higher coinsurance, or higher copays). That means you can qualify for coverage, but you’ll still be responsible for a larger portion of the bill, and in some cases you may face balance billing from the provider. So the correct idea is that out-of-network care may be covered, but at a higher cost.

In a PPO, you can go to out-of-network providers, but you pay more for that choice. The plan usually covers out-of-network services, but at a lower reimbursement rate and with higher patient cost sharing (higher deductible, higher coinsurance, or higher copays). That means you can qualify for coverage, but you’ll still be responsible for a larger portion of the bill, and in some cases you may face balance billing from the provider. So the correct idea is that out-of-network care may be covered, but at a higher cost.