Approved Provider
What Does Approved Provider Mean?
An approved provider is a medical professional or facility that is part of a health insurance plan’s network. Some health insurance plans in the United States have restrictions on which medical providers policyholders can visit. For example, an HMO plan requires policyholders to only see approved providers, except in emergencies. In contrast, a PPO plan allows policyholders to see non-approved providers but at an additional cost.
Insuranceopedia Explains Approved Provider
Health insurance companies maintain a list of approved providers to help control their expenses. A provider can only join this list and treat policyholders if they agree to the insurance company’s fee structure. If a medical provider charges too much, they will not be approved.
Not all insurance companies use a system of approved providers. Some plans allow policyholders to see any medical provider without requiring approval. However, these plans typically come at a higher cost.
