Question 76

Preferred Provider Organizations (PPOs) do not have primary physicians serve as gatekeepers.

In a PPO, patients typically have the freedom to choose their healthcare providers without needing a primary care physician to authorize referrals, which means primary physicians do not act as gatekeepers.

A) primary physicians serve as gatekeepers.

This statement is incorrect regarding PPOs. Unlike Health Maintenance Organizations (HMOs), PPOs allow patients to see specialists and other providers without needing a referral from a primary care physician, thus eliminating the role of gatekeeping.

B) there are incentives to use network providers.

This statement is correct. PPOs often provide financial incentives for members to use network providers, such as lower copayments and coinsurance, encouraging members to seek care from within the preferred network.

C) employees can see specialists without referrals.

This statement is correct. One of the defining features of PPOs is that they allow employees to visit specialists directly without the requirement of a referral from a primary care physician, offering greater flexibility in managing their healthcare.

D) benefits are paid for care received by non-network physicians.

This statement is correct. PPOs typically cover a percentage of the costs incurred when members seek care from non-network providers, albeit at a higher out-of-pocket cost compared to using network providers.

Conclusion

The correct answer, A, accurately reflects a key distinction of PPOs compared to other health plan types, particularly HMOs. All other options highlight characteristics that are true for PPOs, reinforcing the idea that they provide flexibility and choice in healthcare access. Thus, option A stands out as the only statement that does not align with the fundamental principles of Preferred Provider Organizations.