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Thatch details the key differences between PPO and EPO health insurance plans.
In 1980, an early PPO was organized in Denver at St. Luke's Medical Center at the suggestion of Samuel Jenkins, [3] an employee of the Segal Group who consulted with hospitals for Taft-Hartley trust funds. [4]: 6 By 1982, 40 plans were counted and by 1983 variations such as the exclusive provider organization had arisen. [3]
PPO. The Preferred Provider Organization plan is the most popular for those with employment-based insurance (currently 47% of them, in fact). PPOs allow the most flexibility in that people can ...
Managed care plans and strategies proliferated and quickly became nearly ubiquitous in the U.S. However, this rapid growth led to a consumer backlash. Because many managed care health plans are provided by for-profit companies, their cost-control efforts are driven by the need to generate profits and not providing health care. [5]
In the United States, an exclusive provider organization (EPO) is a hybrid health insurance plan in which a primary care provider is not necessary, but health care providers must be seen within a predetermined network. Out-of-network care is not provided, and visits require pre-authorization.
Qualified claims must be described in the HRA plan document at inception: before reimbursing employees for the medical expenses. Arrangements (medical services, dental services, co-pays, coinsurance, deductibles, participation) may vary from plan to plan, and an employer may have multiple plans in place, allowing much flexibility.
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