A Preferred Provider Organization (PPO) is a healthcare system that provides services
to members at a discount or fixed fee. As a result of the discounts agreed to by
participating (preferred) doctors and hospitals, charges for medical services are lower. The
lower charges save money for members, who also avoid filing claims because doctors and hospitals
file the claims with USAble Mutual Insurance Company.
To receive discounts and to have claims filed by doctors and hospitals, members must seek
treatment from PPO-contracted physicians or facilities.
USAble Mutual Connect PPO Preferred Provider Organization
USAble Mutual Connect PPO is a preferred provider organization offered by USAble
Mutual. USAble Mutual Connect PPO assists employers in controlling healthcare
costs by offering a network of doctors and hospitals that have agreed to discount
Through this extensive network of participating doctors and hospitals, the health plan is
able to gain access to more attractive pricing arrangements and better management
of claims costs. Adding proper utilization management to the mix, USAble Mutual Connect
PPO can help control not only the price of healthcare, but also how effectively
healthcare services are delivered.
Simply put, USAble Mutual Connect PPO obtains price discounts from doctors and hospitals and
then passes them along to employers and employees. The plan offers all the benefits
of managed care with fewer restrictions than a traditional HMO. Patients retain
their choice of healthcare doctors and hospitals, with built-in incentives for choosing physicians and facilities
within the network.
Freedom of Choice
Members may choose any doctors and hospitals they wish from the USAble Mutual Connect
PPO network and receive the benefit of negotiated discounts. Members who choose
a doctor and hospital outside the network are responsible for a greater percentage of the allowed
amounts. For example, if a member usually pays 20 percent of the allowed amount
for in-network services, he or she might be required to pay 40 percent of the allowed
amount for out-of-network services. Also, if out-of-network services are chosen,
the member may be responsible for balance billing (the amount above the allowed
amount) by the doctor and hospital.
Affordable Care for Employers and Employees
USAble Mutual Connect PPO offers employers a quality product at a lower cost and
provides predictability for the employer, patient and physician or facility. USAble Mutual Connect
PPO is truly a plan with something for everyone. Employers realize cost savings,
while employees get access to the medical care they need.
With a preferred provider organization, major medical protection is not sacrificed. Employers
have flexibility in choosing copays, deductibles and coinsurance levels that best
fit their group's needs. Also, preventive care benefits can be included. There
are no claims to file when using a PPO doctor or hospital, which reduces paperwork.