Health Insurance Mastery Practice Exam

What type of entity are preferred provider organizations (PPOs) typically classified as?

1. Closed-panel entities

2. Open-panel entities

3. Network-exclusive entities

4. Service-only entities

The correct answer is: Open-panel entities

Preferred provider organizations (PPOs) are classified as open-panel entities because they offer flexibility for patients in choosing healthcare providers. In an open-panel structure, individuals can receive care from both in-network providers, who have agreements with the PPO for reduced rates, and out-of-network providers, who may charge higher co-pays or deductibles. This allows members to access a broader range of services and specialists without needing a referral, which is a key characteristic of the PPO model. This open access enhances patient choice and adaptability in managing their health care needs. The other types of entities mentioned, such as closed-panel entities, would restrict patient access to a specific group of providers, typically requiring referrals and resulting in fewer choices. Network-exclusive entities focus solely on their network and usually do not cover out-of-network care. Service-only entities might not represent a comprehensive healthcare network like PPOs do, which emphasizes both contracted provider arrangements and patient choice.