They say what’s in a name? Nonetheless, when it comes to insurance plans, name really matters. The lines that differentiate various insurance plans, the lines are really blur and most people buy health insurance plans just by name. When it comes to EPO health insurance, there are very few people know what exactly it is. Therefore, we have compiled this article for you containing all the details you need to know about EPO. After reading this you will be fully aware of what is EPO health insurance plan and what does EPO insurance mean?
What is EPO?
EPO or “Exclusive Provider Organization” is a hybrid plan for insurance. In this plan, primary health care provider is not essential. But in this plan health care providers are pre-determined by a network and as a member of EPO insurance network, you cannot approach outside the network for health care. You can use only those hospitals and doctors that are members of EPO network. However, there are few exceptions in cases of emergencies.
What Is EPO Insurance
In this type of insurance, doctors are paid as care providers, while this is not the case in HMO. It is more budget friendly as well. This is the type of insurance where the medical insurance providers and the insurer mutually reach an agreement that is mutually beneficial.
Moreover, visits must be pre-authorized and similarly, non-emergency stays in hospitals are also approved in advance.
What Does EPO Insurance Mean
It is very similar to PPO but it is less flexible. EPO health insurance is essentially a network on individual health practitioners or health care providers or groups of such individuals that provide health care facilities to the policy holders under a written and mutually decided agreement with the insurance provider. Medical expenses are incurred to the EPO insurance policy holders only if they consult the predetermined network of medical practitioners. In return,, those health care providers charge to such subscribers much lesser as compared to other policy holders. Thus, in return of lower rates they get an ever increasing and steady business.
Sometimes, network members contract with each other to consolidate their position and medical practice in a particular geographical area. Policy holders are charged additionally to access the network. EPO policy providers also offer additional services such as resolving conflict between health care providers and policy holders or negotiating fee schedules.
EPO Insurance…Advantages & Disadvantages
The biggest advantage an EPO health insurance provides is the financial flexibility. The lower fees for medical care results in lower monthly insurance premium. You also get specialized health care facilities faster. To compensate for the network limitations, most of EPO insurance plans don’t limit maximum lifetime coverage.
While, the biggest disadvantages that it restraints the buyers. They cannot consult outside the network. In case of emergency, if you consult some doctor or go to some hospital that is not a network member, the expenses won’t be covered and that could be really expensive.
In What Cases EPO Is Beneficial For You
If you don’t know what is an EPO health insurance plan then know it before it’s too late. EPO insurance is beneficial for you if your financial conditions are not very well and you do not want to spend too much on your health insurance plan or if you want to pay lower monthly premium but are willing to pay higher deductible, then also EPO can be right for you. In addition, if you want to avoid a referral to visit some specialist, then EPO health care plan can be suitable for you.
It is also suitable for you if your general health conditions are encouraging and you will live in a specific geographical area. But, if your health conditions are not very well or your job or living standards require you to travel a lot then EPO insurance may not be right for you.