Insurance,
Health Care & Hospital Law
Dec. 4, 2019
Paying for patients: How some providers are distorting health coverage
If you have a PPO plan, you can see out-of-network providers, but it’s going to cost you more. Non-contracted providers have not agreed to accept negotiated rates and can therefore charge what they want. To control health care costs, PPOs have a higher insured cost-sharing requirement for out-of-network services.
Gregory N. Pimstone
Partner
Manatt, Phelps & Phillips LLP
2049 Century Park East, Suite 1700
Los Angeles , CA 90067
Email: gpimstone@manatt.com
UC Berkeley SOL Boalt Hall; Berkeley CA
If you have a PPO plan, you can see out-of-network providers, but it's going to cost you more. Non-contracted providers have not agreed to accept negotiated rates and can therefore charge what they want. To control health care costs, PPOs have a higher insured cost-sharing requirement for out-of-network services. The reduced benefits for out-of-network services is a structural feature of PPOs tha...
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