Denny Weinberg joined a founding team to become the chief executive officer of the digital health benefits technology company, Hixme.com. During a legendary career with Wellpoint (now Anthem), Denny Weinberg was widely regarded among other things, as an original architect of the preferred provider (PPO) health insurance model, still the most prominent form of Managed Care.
A PPO brings together medical doctors, hospitals, and other ancillary providers with an insurer to provide health care services to its member clients at reduced prices. A PPO health care plan has its own network of doctors and physicians, referred to as in-network providers, who are available to treat any of the participating clients without the financial hassles of claims, patient billing and reimbursements. PPO patients can still go to an “out-of-network” provider, but they will pay more; additionally, they will have to pay the costs themselves, then later file a claim with the PPO to be reimbursed. This is a largely misunderstood option and often very workable when people have special relationships with doctors that they don’t want to interrupt. People learn over time, that when a doctor says, “I don’t take that plan”, what they really mean is I am “out of network”, but happy so be your doctor. Often, a patient receiving care from an “out of network doctor or other provider” will discount their bill since the patient will be paying cash up front and then billing their insurance company later.
Some of the benefits of PPO health plans are flexibility, in that members are free to choose a physician from the wide variety of physicians covered in the plan and can do so without first getting a referral from a Primary Care Physician (PCP), and reduced paperwork for members who visit in-network physicians.