In PPOs, what can happen if a patient uses out-of-network services?

In a Preferred Provider Organization (PPO), patients have the flexibility to seek care from both in-network and out-of-network providers. However, when patients choose to use out-of-network services, they typically face higher out-of-pocket expenses. This is because out-of-network providers have not agreed to the PPO's negotiated rates, leading to increased costs for the patient.

When utilizing out-of-network services, patients often have a higher coinsurance rate, and they may also be subject to higher deductibles compared to using in-network services. This financial structure is designed to incentivize members to utilize in-network providers, who have agreed to provide services at lower costs within the PPO's network. Understanding this will help patients navigate their healthcare options and manage their expenses effectively.