EPO Insurance Plans - An EPO insurance plan is a network of individual medical care providers, or groups of medical care providers, who have entered into written agreements with an insurer to provide health insurance to subscribers. Basically, an EPO is a much smaller PPO. EPO insurance plans offer a very limited number of providers who offer large discounts on their rates.
Types of EPO Insurance plans
The current industry standard requires that a patient select a Primary Care Physician and when needed obtain authorization from that Primary Care Physician to receive specialty services. Some patients may not have to choose a Primary Care Physician and only have to choose a medical group. A patient must stay within the contract network and only use preferred providers. There typically is a lifetime policy maximum with this type of plan. If a patient goes out of network they may be responsible for the entire balance that is not paid by the payer associated with the services provided.
The other type of EPO insurance plan is one where the benefits are those of a PPO insurance plan but the provider panel from which members obtain care is smaller than a PPO insurance plan panel.
EPO Insurance plans
Things to know before joining a EPO Insurance Plans
Does the organization provide what you think you will need in the future?
Do you have any special needs?
If you have your own provider or specialists, do they belong to the network or must you switch to the EPO network
Research the EPO Insurance Plan of choice and compare
Does the EPO have a history of quality care
Are the charges within reason, or would you be better served by an insurance plan, check if the plan is partially paid for by your employer