FAQs
Select from the list of frequently asked questions or just scroll
down the page to view all the FAQs.
What is Preferred Choices PPO?
What is a Preferred Provider Organization
(PPO)?
Is Preferred Choices PPO my insurance company?
What are some of the advantages of choosing
a Preferred Choices PPO network provider?
How do I access the Preferred Choices PPO provider
network?
What types of physicians belong to Preferred
Choices PPO?
Why does the care I receive in the Preferred
Choices PPO Network cost me less than the care I receive outside
the Network?
How often can I see my Preferred Choices PPO
network provider?
Does Preferred Choices PPO plan require that
I select a Primary Care Physician (PCP) in advance?
What if I need Specialty Care? Can I choose the
specialist? Must it be a Preferred Choices PPO physician?
How can I find out if my provider is already
in the Preferred Choices network?
My doctor is not in the Preferred Choices PPO
directory. What should I do?
As a Preferred Choices PPO member, must I use
only physicians and hospitals participating in the Preferred Choices
PPO Network?
If I use the Preferred Choices PPO network, will
I have to fill out a lot of extra paperwork?
Whom should I contact if I have a concern about
a provider?
Who do I call when I have a question?
What should I do in the event of an emergency?
Q. What is Preferred Choices PPO?
A. Preferred Choices is a network of physicians, hospitals,
and other health care providers that partner together to reduce
your out-of-pocket health care costs. You will have greater benefits
and less out-of-pocket cost by choosing Preferred Choices PPO providers.
Preferred Choices is offered as a PPO provider network and works
with your current benefit or plan administrator.
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Q. What is a Preferred Provider Organization
(PPO)?
A. A PPO is a managed care arrangement created to
offer quality, cost-effective health care through a network
of respected, well-established physicians, hospitals and
other medical care providers. Preferred Choices PPO has
organized a network of prescreened doctors, hospitals and
other health care providers who have agreed to offer their
services to you at rates that are usually much lower than
their normal rates. Thus, Preferred Choices PPO helps reduce
the cost of quality medical care for both you and your
health plan.
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Q. Is Preferred Choices PPO my insurance
company?
A. No, Preferred Choices is not your insurance company.
Preferred Choices is your PPO provider network. Preferred
Choices PPO discounts the claims from participating providers
and forward them to your benefits administrator or insurance
carrier for processing. Preferred Choices PPO does not
pay your benefits, process claims for providers, or determine
benefits coverage and eligibility.
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Q. What are some of the advantages of
choosing a Preferred Choices PPO network provider?
A. Advantages to choosing a Preferred Choices PPO
provider:
- You choose a quality health care provider
- Lower costs and less paperwork. When you use a Preferred Choices
PPO provider, your cost is reduced because of the higher benefit
levels paid by your health plan.
- You pay the provider only the amount you owe under your health
plan to cover the copayment as well as any deductible and coinsurance.
- There are no claims forms to fill out when you use a participating
Preferred Choices PPO provider or hospital; they do the work for
you.
- No referrals for care are required.
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Q. How do I access the Preferred Choices
PPO provider network?
A: Once you enroll through your employer, you will receive a member identification
card. This card is very important. It identifies you as a participant in a
health plan that includes the Preferred Choices PPO provider network. The ID
card should also include important information and phone numbers for both you
and your doctor.
To receive medical care, simply call a participating Preferred Choices
PPO provider located in the provider directory, confirm their participation
and schedule an appointment. Your provider will want to see your
ID card, so be sure to bring it with you each time you have an appointment.
If you have questions about your coverage for utilizing providers
who do not participate with Preferred Choices PPO, you must contact
your health plan administrator or your employer's human resource
representative.
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Q. What types of physicians belong to
Preferred Choices PPO?
A. The Preferred Choices PPO network includes more
than 10,000 physicians and 74 hospitals throughout Michigan.
In addition, our network is always growing. Each physician
must meet our high quality standards.
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Q. Why does the care I receive in the
Preferred Choices PPO Network cost me less than the care I receive
outside the Network?
A. Costs are lower for covered services in the Network
for the following reasons:
- Participating providers agree to negotiated fees or discounts.
- You are not balance billed for the difference between the negotiated
fee and the actual charge.
- Your share of the cost for medical service and coinsurance is
lower for services rendered in the network.
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Q. How often may I see my Preferred Choices
PPO network provider?
A: You may see your network provider as often as you feel is necessary.
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Q. Does Preferred Choices PPO require that
I select a Primary Care Physician (PCP) in advance?
A. A PPO plan, like Preferred Choices, does not
require pre-selection of a PCP. It is recommended that
you select a primary care physician who can help to coordinate
your care with physician specialists.
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Q. What if I need Specialty Care? Can I
choose the specialist? Must it be a Preferred Choices PPO physician?
A. The choice is yours. You do not need a referral
to see a specialist. However, if you decide to use an out
of network physician or other providers, you may be subject
to applicable out-of-network benefits and may have to pay
more out-of-pocket costs. To find a specialist in the Preferred
Choices PPO network, review the provider directory or ask
your doctor to refer you to a participating Preferred Choices
provider.
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Q: How can I find out if my provider is
already in the Preferred Choices network?
A: You can access our online Provider Directory to
search our broad network of providers. You may also call Customer Service at
1-800-992-6837 and ask for a provider directory to be sent to you. It is always
a good idea to call a provider's office to verify participation before you
seek care.
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Q. My doctor is not in the Preferred Choices
PPO directory. What should I do?
A. First, call Preferred Choices PPO to find out
if your doctor has been added to the network since the
printing of the directory. If your doctor is not currently
a member, you have several options.
- You can select a new doctor who is in the network
- Continue to see the doctor realizing that you will pay a higher
out-of-pocket cost each time you receive care from the doctor
- Contact your benefit administrator and let them know that your
doctor is not in the Preferred Choices network. The administrator
will work with the Insurance company/TPA to contact Preferred Choices
PPO to discuss adding the provider to the network.
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Q. As a Preferred Choices PPO member, must
I use only physicians and hospitals participating in the Preferred
Choices PPO Network?
A. You receive enhanced benefit coverage by using
the providers in the Preferred Choices PPO network. However,
if you choose a non-participating provider, your benefits
may be lower, so you may pay a larger portion of the cost.
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Q. If I use the Preferred Choices PPO network,
will I have to fill out a lot of extra paperwork?
A. No. Unless your insurance carrier requires more
information from you, the paperwork for Preferred Choices
PPO is handled directly by your participating Preferred
Choices PPO health care provider.
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Q. Whom should I contact if I have a concern
about a provider?
A. If you experience a problem with a network provider,
contact the Preferred Choices PPO Customer Service department
at 1-800-992-6837.
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Q. Where do I call when I have a question?
A. You should always call your health plan administrator
with questions or problems regarding eligibility or benefits,
ID cards, plan provisions or problems with a specific claim.
If you have questions about Preferred Choices PPO providers
or how to use the Preferred Choices PPO network, call the
Preferred Choices PPO Customer Service department at 1-800-992-6837.
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Q: What should I do in the event
of an emergency?
A: In an emergency, it is important to obtain the necessary medical care as
soon as possible. If you have any concerns about how your benefits are paid
for emergency treatment, consult your employer benefits department or your
Summary of Benefits for more details.
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