An EPO (Exclusive Provider Organization) is a type of PPO (Preferred Provider Organization) which restricts patients from choosing physicians within the network in order to qualify for plan benefits. An EPO insurance plan is a network of group of medical care providers, or individual medical care providers, who have contracted with an insurer to provide health insurance to subscribers.
Basically, an EPO is a variation on the PPO. It offers a very limited number of providers who offer large discounts on their rates. With a PPO, if you visit a doctor out-of-network, you'll be expected to pay the cost of the visit. After that, you can submit a claim form to the insurance company, and wait to see if they reimburse you. In an EPO, if you want to visit a out-of-network doctor, you have to pay for it and your insurance company will not even consider reimbursing you.
Having an EPO means that the medical service providers, who will provide you health care, should have contracted with the insurance company to allow offering you these services. The person having such a plane can get some inexpensive medical services at a facility making a part of the EPO network.
When you select such a plan, you will notice that the fees charged by the medical service providers who have accepted to join your insurance company are significantly lower than the normal charges. So, while receiving your health benefits within the EPO network, you can rest assure that the rates you will be charged will be advantageous and your insurance provider will pay for all the services you receive.
As a conclusion, the EPO plans would be appealing to those who are looking for cheap health insurance and without any special medical needs such as pre-existing conditions. The people who will probably get benefit from such plans are healthy and young workers with no serious health risks. The older people with complicated conditions may find it quite uncomfortable because they need regular and special care from certain specialist, who may be out-of-network. So, before purchasing such a plan, think well and make sure to shop around to get the best rates. Contact your insurance agent to find out what local providers can offer and start from there.
