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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 ...
PPO: This plan offers high flexibility, allowing visits to any doctor or specialist without referrals, including out-of-network providers, at a higher cost. EPO: Requires using in-network ...
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.
Self-funded plans take one step further in that they provide all claims data to employers allowing them to set up an EPO (exclusive provider organization) basically a PPO hand-selected by the organization to eliminate high-cost providers.
There is a continuum of organizations that provide managed care, each operating with slightly different business models. Some organizations are made of physicians, and others are combinations of physicians, hospitals, and other providers. Here is a list of common organizations: Group practice without walls; Independent practice association
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. The terms "open panel" and "closed panel" are sometimes used to describe which health care providers in a community have the opportunity to participate in a plan.
Exclusive provider organization (EPO) Health maintenance organization (HMO) Preferred provider organization (PPO) Medical underwriting; Health care reform law.