Under PPO plans, what typically happens if a member chooses to go out-of-network for treatment?

In Preferred Provider Organization (PPO) plans, members have the flexibility to seek care from any healthcare provider, including those outside of the insurance network. However, when a member opts to go out-of-network, they typically face higher out-of-pocket costs. This is because PPO structures incentivize using in-network providers by offering lower co-pays and higher coverage percentages for those services. Out-of-network providers often charge more than those within the network, and as a result, insurance plans may cover a smaller percentage of the total cost, leaving the member responsible for a larger share of the bill. This is a fundamental aspect of how PPO plans are designed to encourage members to utilize network providers for cost efficiency and better coverage.

The other options do not align with how PPO plans operate. Members are not denied care outside the network, nor are they completely covered for all expenses incurred while using out-of-network services. Generally, pre-authorization is not a requirement for out-of-network services, making choice B the most accurate reflection of the typical outcomes associated with seeking out-of-network treatment.