Preferred Provider Organization (PPO) Plans FAQ
- What is a PPO Plan?
- How will I benefit from using the PPO physicians and hospitals?
- How do I use the PPO when I need healthcare?
- Do all family members have to choose the same PPO provider?
- What if my family physician is not in this directory?
- What should I do in a medical emergency?
- How are my claims handled?
- What happens if my benefit plan does not cover a service which I have received from a preferred provider?
- How do I find out what my benefits will be when using PPO physicians and hospitals?
- What is the address for filing a claim?
What is a PPO Plan?
A PPO, or Preferred Provider Organization, contracts with physicians and hospitals to secure preferred rates for you and your covered family members. You can decide to visit a PPO provider any time medical care is needed. Should you choose a non-PPO provider, a lower level of benefit may apply. When you choose a PPO provider, you will receive quality medical care and the highest level of benefits. ODS contracts with several PPO networks to provide more physician choices and geographic coverage.
How will I benefit from using the PPO physicians and hospitals?
You will benefit for the following reasons:
- You will be receiving quality healthcare from some of the area's most respected private practice physicians and hospitals.
- Your health insurance will offer the highest level of benefits when you use PPO physicians and hospitals.
- You will save money through lower out-of-pocket expenses. Remember, participating preferred providers (physicians and hospitals) agree to accept preferred rates for services provided to ODS members like you.
- There is no additional paperwork. PPO physicians and hospitals bill ODS for you.
- Your PPO provider will assist with preauthorization requirements.
How do I use the PPO when I need healthcare?
Follow the directions below:
- Select your physician or hospital from the correct PPO network in our directory.
- Identify yourself as a "PPO member" when you make your appointment (be sure to give your group and ID numbers).
- Show your ID card when you arrive.
- Savings are automatic, and the physician or hospital bills ODS directly.
Do all family members have to choose the same PPO provider?
No. Each family member may choose his or her own provider. However, the use of a PPO provider (whether the same as yours or not) results in higher benefits.
What if my family physician is not in this directory?
You may decide to visit a non-PPO physician, however any allowable services will be paid at lower benefit levels than if you visited a PPO physician.
What should I do in a medical emergency?
In the event of an emergency you are covered worldwide 24 hours a day. Emergency medical condition means a medical condition that manifests itself by symptoms of sufficient severity that a prudent layperson possessing an average knowledge of health and medicine would reasonably expect that failure to receive immediate medical attention would place the health of a person, or a fetus in the case of a pregnant woman, in serious jeopardy.* In such a case you should proceed to the closest medical facility for care. In the case where a non-participating facility or provider is used for follow up care to a medical emergency, lower out-of-network benefits will apply.
How are my claims handled?
If you use a PPO provider, they will bill ODS directly.
Q: What happens if my benefit plan does not cover a service which I have received from a preferred provider?
For services not covered by your health benefit plan, you will be responsible for paying the provider's fee.
How do I find out what my benefits will be when using PPO physicians and hospitals?
Please refer to your Member Handbook or contact Customer Service.
What is the address for filing a claim?
Send claims to:
ODS Companies
PO Box 40384
Portland, OR. 97240-0384
Please be sure the following information is included:
- Patient's name, identification number, and group ID number
- Date of treatment
- Diagnosis
- An itemized description of services and charges
If the treatment is for an accidental injury, include a statement explaining the date, time, place, and circumstances of the accident when you send us the physician or professional provider's bill.
*This is our standard contract wording, your plan may be different so please reference your member handbook for what applies to your plan.