A Preferred Provider Organization (PPO) is a health-care system that provides
services to members at a discount or fixed fee. As a result of the discounts
agreed to by participating (preferred) providers, charges for medical services
are lower. The lower charges save money for members, who also avoid filing
claims because providers file the claims with USAble Administrators.
To receive discounts and to have claims filed by providers, members must seek
treatment from PPO-contracted physicians or facilities.
USAble Administrators offers participation in the USAble® PPO to self-funded
employer groups. However, a group may choose to access a different network
How USAble PPO Works
USAble PPO is a preferred provider organization offered by USAble Corporation.
USAble PPO assists employers in controlling healthcare costs by offering a
network of doctors and hospitals that have agreed to discount their fees. More
than 4,850 health professionals and 92 hospitals participate in the USAble PPO
Through this statewide network of participating providers, the health plan is
able to gain access to more attractive pricing arrangements and better
management of claim costs. Adding proper utilization management to the mix,
USAble PPO can help control not only the price of health-care, but also how
effectively healthcare services are delivered.
Simply put, USAble PPO obtains price discounts from providers and then passes
them along to employers and employees. The plan offers all the benefits of
managed care with fewer restrictions than a traditional HMO (health maintenance
organization). Patients retain their choice of health-care providers, with
built-in incentives for choosing providers within the network.
Usually, the benefit structure is similar to comprehensive major medical (CMM)
plans, featuring a calendar-year deductible, coinsurance and calendar-year
coinsurance maximum or out-of-pocket maximum. The PPO works very much like CMM
in terms of benefits, although the PPO does have some benefits that differ.
In-network PPO benefits are typically greater than out-of-network benefits
because of different coinsurance levels. This principle usually applies to
copays, deductibles and calendar-year coinsurance maximum or out-of-pocket
maximums. Lower in-network costs steer utilization to participating providers.
Example: In-network PPO benefits may include a $100 calendar-year
deductible, $10 office-visit copay and 90 percent benefit up to an
out-of-pocket maximum of $500. In comparison, out-of-network benefits under the
plan may include a $300 calendar-year deductible, $25 office-visit copay, 70
percent benefit up to an out-of-pocket maximum of $1,000.
The information above is an example only. The benefits designed by your employer
group are unique to your plan. Check your
USAble® PPO Provider Directory
The USAble® PPO Provider Directory provides
information about health-care providers and hospitals who participate in the USAble® PPO program. You can view
the provider's hospital affiliations, board certifications and education information. This directory displays
only the USAble® PPO network. Consult your benefits booklet or contact Customer Service for more information
specific to your medical plan.
Guests may browse the Guest Provider Directory,
but please refer to your benefit booklet or call Customer Service to determine if your Plan accesses the networks.
Freedom of Choice
Members may choose any health-care provider they wish from within the statewide
network and receive the benefit of the negotiated fee discounts.
Affordable Care for Employers and Employees
With USAble PPO, there is no sacrifice of major medical protection. Employers
also have the flexibility to choose the deductible that best fits their group's
needs. And there are no claims to file when using a PPO doctor or hospital,
which reduces paperwork.
USAble PPO offers employers a quality product at a lower cost and provides
predictability for the employer, patient and provider.
USAble PPO is truly a plan with something for everyone. Employers realize cost
savings, while employees get access to the medical care they need. It's no
wonder USAble PPO is the number-one PPO in Arkansas, serving more than 442,000
USAble Administrators may not be your employer's third-party claim
administrator. However, your employer may access the USAble PPO network. By
payment of a monthly fee, employers can lease access, thereby enjoying the
benefit of discounted medical services.