Difficulty: Easy

Average Score: 100%

All of the following are features of a Preferred Provider Organization (PPO) EXCEPT

Rationale

Primary care physicians act as gatekeepers.

In a Preferred Provider Organization (PPO), patients have the flexibility to choose their healthcare providers without needing referrals from primary care physicians, which is a key distinguishing feature of this type of plan.

A (employees have a choice of practitioners.) YOUR ANSWER

This statement accurately reflects a core characteristic of PPOs, allowing members to select from a wide network of doctors and specialists. This flexibility is one of the primary advantages of PPOs compared to more restrictive health plan models such as Health Maintenance Organizations (HMOs).

B (primary care physicians act as gatekeepers.) CORRECT

This statement is false regarding PPOs. In a PPO plan, members do not need to go through a primary care physician to obtain referrals for specialist services. Instead, they can directly access specialists within the network, allowing for greater autonomy and reduced delays in receiving care.

C (providers are paid on a fee-for-service basis.) YOUR ANSWER

This statement is true of PPOs, where healthcare providers are compensated for each service rendered. This fee-for-service model incentivizes the provision of services but can lead to higher overall healthcare costs, distinguishing it from capitation models used in some other healthcare plans.

D (dependents do not need referrals to see a specialist.) YOUR ANSWER

This statement is also true for PPOs. Dependents covered under a PPO plan enjoy the same flexibility as the primary members, allowing them to see specialists without requiring prior referrals, which enhances access to specialized care.

Conclusion

In summary, PPOs are characterized by a member-centric approach that allows direct access to specialists and flexibility in choosing healthcare providers. The role of primary care physicians as gatekeepers is not a feature of PPOs, setting them apart from other health plan structures. This structure promotes patient autonomy and quick access to necessary healthcare services.

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