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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.
EPO. An Exclusive Provider Organization plan, like a POS, combines different facets of basic HMO and PPO plans. Unlike POS and HMO plans, however, EPOs allow you to choose your own PCP and see ...
Exclusive provider organization (EPO) Health maintenance organization (HMO) Preferred provider organization (PPO) Medical underwriting; Health care reform law.
Preferred provider organizations themselves earn money by charging an access fee to the insurance company for the use of their network (unlike the usual insurance with premiums and corresponding payments paid fully or partially by the insurance provider to the medical doctor).
A PPO is similar to an exclusive provider organization (EPO) in structure, administration, and operation. Unlike EPO members, however, PPO members are reimbursed for using medical care providers outside of their network of designated doctors and hospitals.
Open network plans provide some coverage when an enrollee uses non-network provider, generally at a lower benefit level to encourage the use of network providers. Most preferred provider organization plans are open-network (those that are not are often described as exclusive provider organizations, or EPOs), as are point of service (POS) plans.
Exclusive provider organization (EPO) Health maintenance organization (HMO) Preferred provider organization (PPO) Medical underwriting; Health care reform law.
Exclusive provider organization (EPO) Health maintenance organization (HMO) Preferred provider organization (PPO) Medical underwriting; Health care reform law.