Comparing Healthcare Plans

Exclusive Provider Organizations

Exclusive provider organizations (EPOs) are relatively unknown but offer another opportunity for care in the network and referral interplay. EPOs emphasize the 'exclusive' in its name. Out-of-network providers are not covered, as with HMOs. However, in-network specialists and primary care physicians can be visited without a referral, which adds more flexibility than the typical HMO plan. With EPOs, the quality and breadth of in-network primaries and specialists are paramount. Saving money on an EPO with a more scant network will very likely not pay off since any out-of-network care, no matter how justified from a medical perspective, is not contractually covered. As with other out-of-network disincentives, this is done to keep the EPO financially viable and give customers reasonable prices for in-network coverage.

It's time to talk about preferred provider organizations. Keep reading for more!