Approved Provider

Published: | Updated: April 16, 2018

Definition - What does Approved Provider mean?

An approved provider is a medical provider who is part of a health insurance plan’s network. Some health insurance plans in the United States have restrictions on which medical providers the policyholders can see. An HMO plan requires policyholders to only see approved providers, except in emergencies. A PPO plan allows policyholders to see non-approved providers for an extra fee.

Insuranceopedia explains Approved Provider

Health insurance companies have a list of approved providers to keep their expenses under control. A provider can only join a list and have policyholders as patients if the providers agree to the insurance company's fee structure. If the medical provider charges too much, then they will not be approved.

Not all insurance companies use a system of approved providers. Some plans allow policyholders to see any medical provider they want without approval. However, these insurance plans typically cost more.

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