USAble Administrators

USAble® PPO

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 arrangement.

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 network.

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 Plan Benefits.

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 Arkansans.

Access Only

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.