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FAQ

Personal Choice^® PPO

What is a Preferred Provider Organization (PPO)?

What is the meaning of in-network/out-of-network benefits?

Can you tell me if my doctor or hospital is in the Personal Choice network?

What is a Preferred Provider Organization (PPO)?
PPOs are a combination of fee-for-service and HMO programs. They offer the preventive benefits of an HMO and the freedom of traditional insurance to choose the doctor or hospital you want.

PPOs give you a financial incentive to use in-network (preferred) providers. When you do, a greater portion of the cost of services is covered. But you can opt for out-of-network doctors or facilities and still receive some coverage. When you receive care out-of-network, you will be responsible for a deductible and coinsurance. In addition, out-of-network non-participating providers may bill you for the differences between the plan allowance and the provider's actual charge.

Unlike an HMO, PPOs do not require you to coordinate your care through a Primary Care Physician or obtain a referral to see a specialist.

What is the meaning of in-network/out-of-network benefits?
When you use a provider that participates in the Personal Choice network or the BlueCard^® PPO program, they are considered in-network. Providers that do not participate in the Personal Choice network or BlueCard PPO are considered out-of-network and your benefits are reduced.

Can you tell me if my doctor or hospital is in the Personal Choice network?
To find a participating provider, use the online provider search. Or call Personal Choice Member Services at 215-557-7577 or 1-800-626-8144 (outside the Philadelphia area).