Maria is a Preferred Provider Organization (PPO) subscriber who received care from an out-of-network provider. What is the expected result?

In a Preferred Provider Organization (PPO) plan, subscribers typically have the flexibility to receive care from both in-network and out-of-network providers. However, the way care is covered varies based on the choice of provider.

When a PPO subscriber, such as Maria, opts to receive care from an out-of-network provider, the care is indeed covered, but generally at a lower reimbursement rate compared to in-network care. This is because PPO plans incentivize the use of a network of preferred providers who have agreed to provide services at negotiated rates. Therefore, while Maria's out-of-network care is covered, it may result in higher out-of-pocket expenses for her, as insurance will pay less compared to what it would for in-network services.

The nature of PPO plans allows for this flexibility, which is appealing to many subscribers who want to choose their providers without the limitations of strict in-network only options. However, this comes with the trade-off of potentially higher costs when going out-of-network.