Question 49

Primary care physicians act as gatekeepers is not a feature of a Preferred Provider Organization (PPO).

In a Preferred Provider Organization (PPO), patients do not require primary care physicians to act as gatekeepers, allowing them greater flexibility in choosing specialists without needing a referral.

A) employees have a choice of practitioners.

This statement is true and describes a key feature of PPOs. Members have the freedom to select from a network of healthcare providers, which enhances their ability to choose practitioners that best meet their needs.

B) primary care physicians act as gatekeepers.

This statement is incorrect as it contradicts a fundamental aspect of PPOs. Unlike Health Maintenance Organizations (HMOs), PPOs do not require members to obtain referrals from primary care physicians to see specialists, thereby eliminating the gatekeeping function.

C) providers are paid on a fee-for-service basis.

This statement accurately reflects how PPOs typically operate. Providers in a PPO are often compensated on a fee-for-service basis, meaning they receive payment for each service they deliver, which incentivizes a wide range of treatment options.

D) dependents do not need referrals to see a specialist.

This statement is also true and aligns with the characteristics of PPOs. Dependents on a PPO plan can visit specialists directly without requiring a referral, further emphasizing the flexibility of the plan.

Conclusion

The statement about primary care physicians acting as gatekeepers is not a characteristic of a Preferred Provider Organization, making it the correct answer. In contrast, the other options highlight essential features of PPOs, such as provider choice, fee-for-service payment structures, and the lack of referral requirements for specialists. This distinction is crucial for understanding how PPOs differ from other healthcare plans.