Maria is a Preferred Provider Organization (PPO) subscriber and received care from an out-of-network provider. Which of the following is the likely result?

When a subscriber like Maria is enrolled in a Preferred Provider Organization (PPO) plan, one of the key features of this type of insurance is flexibility in choosing healthcare providers. While PPOs encourage the use of in-network providers by offering greater benefits and lower out-of-pocket costs, they also provide coverage for care received from out-of-network providers.

In this scenario, since Maria received care from an out-of-network provider, her PPO plan is still likely to cover a portion of those costs, albeit at a lower reimbursement rate compared to in-network services. This design allows subscribers to seek care where they wish, ensuring access to a broader range of health services.

It's important to note that while care from out-of-network providers is covered, it may involve higher deductibles, copayments, or coinsurance compared to in-network providers. Furthermore, there typically aren't the same prior authorization requirements for all out-of-network care as there might be with some managed care plans.

Understanding this mechanism within PPO plans elucidates why the answer is that care is covered, reflecting the inherent flexibility and choice that these plans offer their members.