Exclusive Provider Organization (EPO) Plan - Health Insurance

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What Is an Exclusive Provider Organization (EPO) Plan in Health Insurance?

<lingo>An Exclusive Provider Organization (EPO) plan is a type of managed healthcare insurance plan. In this plan, the coverage provides only financial payment if you go to the specific doctors and specialists that are listed within the plan’s network. That network is preestablished, which means you need to choose the providers you need from the plan in advance of receiving care. If there is an emergency situation, this does not apply, as long as it is considered a true life-threatening situation. This type of plan is just one option among numerous health care coverage plans.</lingo>

Exclusive Provider Organization (EPO) Plan Clearly and Briefly Explained

An EPO plan is one of the more common options available in health insurance plans. If you are a policyholder with an EPO plan, you generally will have a large network of medical providers including specialists and hospitals from which to choose your care from. It is very important that you examine the plan carefully. If you have existing doctors or hope to use a specific medical facility, it is a good idea to verify that that particular provider is available within your EPO plan. You can usually do this rather easily by verifying coverage with your agent.


<twitter>An Exclusive Provider Organization (EPO) plan is a type of managed healthcare insurance plan.</twitter>



If you choose to go to a provider that is not on the plan, this is considered an out-of-network service. As a result, you may not have any coverage from your insurance company for this type of care.


In situations where a true emergency happens, your goal is to get medical care right away. In this situation, you do not have to wait for approval from your insurance carrier. Instead, simply get care right away. Most of the time, EPO plans do not consider non-emergency services coverable, though.


In some situations, you may be able to get approval in advance of care to use an out-of-network provider. This may be possible for some types of outpatient procedures as well as for some maternity stays. Your plan will outline when this is an option for you to consider.


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