What type of health insurance plan does Shelly have if she went to an out-of-network doctor?

Prepare for the Florida Certified Insurance Representative Exam. Use multiple choice questions and detailed explanations to enhance your study sessions. Improve your chances of success!

The most appropriate type of health insurance plan for someone who visits an out-of-network doctor is a Preferred Provider Organization (PPO). PPO plans typically allow members to see any healthcare provider, including those outside of their insurance network, though there may be higher out-of-pocket costs associated with that choice.

On the other hand, a Health Maintenance Organization (HMO) generally requires members to select a primary care physician and receive referrals for specialists, with coverage typically limited to network providers, making it less likely for an out-of-network visit to be fully covered. An Exclusive Provider Organization (EPO) operates similarly to an HMO, as it also usually does not cover out-of-network services unless in an emergency. A service plan is not a commonly recognized term in this context and does not accurately reflect a specific type of health insurance.

Thus, the rationale for selecting a plan that accommodates out-of-network visits leans toward a PPO, as it offers the flexibility in provider choices without the stringent network restrictions found in other plan types.

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