Covered persons are generally allowed benefits for non-participating providers' services, usually on an indemnity basis with significant copayments. A PPO arrangement can be insured or self-funded. A PPO is a network of doctors and hospitals created by an insurance company or employer to provide care at a lower cost than traditional insurance. An approach to medicine based on identifying and addressing problems that affect specific groups of people. Traditionally, doctors treated individuals and their symptoms.
Care is based on clinical, service, and cost outcomes.
A concept of how we might contract with community doctors to provide care for enrollees in geographic locations that don't have a medical center, or where another choice might increase enrollment. A quality improvement team. Red rules, blue rules Red rules are policies and regulations that are unbreakable and unbendable - such as maintaining patient confidentiality. Blue rules are those that can and should be broken if circumstances demand flexibility - such as waiving a copay for a patient to respond to a service breakdown. One of the most important contributors to consumer satisfaction and retention.