A member who is enrolled in a Preferred Provider Organization (PPO) decides to utilize a physician outside the network. How would this affect the member?

This option is incorrect because PPO plans generally do not require referrals or authorization from a primary care physician in order to see specialists or receive treatment. Referral requirements are more commonly associated with Health Maintenance Organizations (HMOs).

A PPO is not considered a closed plan. Unlike some managed care plans that restrict coverage to network providers only, PPOs allow members to seek care outside the network. Although benefits are still available, the insured must pay a greater share of the costs.

This answer is incorrect because using an out-of-network provider in a PPO plan typically results in higher deductibles, copayments, or coinsurance amounts for the member. Therefore, there is a financial impact when choosing providers outside the network.