CARD Q068
Which feature commonly distinguishes a PPO from a traditional HMO?
- Specialist visits always require a PCP referral
- Covered out-of-network care is usually available at higher member cost
- Only emergency care is covered without advance authorization
- Routine out-of-network care is excluded in every case
Covered out-of-network care is usually available at higher member cost
PPOs generally allow more out-of-network flexibility. Traditional HMOs emphasize networks and referrals, with exceptions such as emergency care.
Why each choice is right or wrong
A. Specialist visits always require a PCP referral
Incorrect. PPO specialist access commonly does not require a PCP referral.
B. Covered out-of-network care is usually available at higher member cost
Correct. PPOs generally allow more out-of-network flexibility. Traditional HMOs emphasize networks and referrals, with exceptions such as emergency care.
C. Only emergency care is covered without advance authorization
Incorrect. Advance authorization rules vary; this is not the general defining PPO feature.
D. Routine out-of-network care is excluded in every case
Incorrect. PPOs commonly cover out-of-network care, so the absolute exclusion is wrong.
Review the related terms
Use these lessons to revisit the concepts and try additional practice questions.