Andrew has a PPO through Acme. The list of preferred providers does not include his primary care physician. If Andrew continues to see this doctor, what will happen?

Question

Quizplus · Accepted Answer

If Andrew continues to see this doctor, a reduced amount will be paid and Andrew will pay the rest. PPO arrangements pay full benefits when preferred provides are used. If a participant chooses a non-preferred provider, the PPO will pay a reduced amount, typically 80%, and Andrew will have to cover the rest out of pocket.
Theory

Andrew Has a PPO Through Acme