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Blog

Crossword 146: PPO

September 4, 2020 David Bywaters
George Dunlop Leslie, Pot-Pourri

George Dunlop Leslie, Pot-Pourri


Since I intend my puzzles to last forever, I will add an explanation of this one, for the benefit of the solver of the future.

PPO, then, future solver, once stood for “Preferred Provider Organization.”  Years ago, health care was arranged rather to maximize the profits of private industry than to promote public health.  If you expected ever to need health care, you were advised to buy “insurance” from a private entity:  you would pay this entity a monthly fee, and in return it would pay a percentage of your doctor’s fees—over a certain fixed “deductible” amount.  

So say you paid this entity $2000/month, in exchange for which it agreed to cover 80% of your medical costs after a $1000 annual deductible.  Say that, after 30 years of this,  you got a disease and had to go to the hospital for a week.  And say the hospital charged you $101,000 for your treatment.  Lucky you!—you paid only $21,000 (your deductible plus 20% of your costs); your insurer covered the remaining $80,0000!  And lucky insurer—having collected $720,000 from you over your 30 years of participation, it still got to keep $640,000!  It seems a little crazy now, future solver, but the theory was that everybody benefited.  The hospital got lots of money, the insurer got lots of money, and you didn’t die.

But there was a further little hitch, or snag, in the process.  Most insurers agreed to pay 80% of your fees only if you paid them to certain selected doctors, who had previously made a deal with those insurers.  Otherwise the insurers would pay only 60%, or 40% of your costs, or maybe even nothing at all.  These selected doctors were collectively known as a “Preferred Provider Organization” or PPO.

So, future solver, however bleak things may seem at the moment, don’t forget to remind yourself—at least it’s not 2020.


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146 PPO

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