Quote:
Originally posted by ltl/fb
. I'm not sure that even "participating" facilities in PPOs necessarily won't charge you more than what the insurer/plan deems reasonable and reimburses, but I could be wrong on that.
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Based solely on my limited experience with two PPOs, they do send me a wonderful explanation of benefits telling me what the outrageous charge was, what the negotiated (and far more reasonable) charge was, what I don't have to pay/they saved me, and what I do have to pay (deductible and/or copay). So, I conclude that with any PPO, a participating provider charges only what's reasonable and reimburses, at least net.
It also has taught me if you go outside the PPO, they stick it up your ass real hard, because they give you the high rate, regardless of whether they would otherwise negotiate with someone else.
