Exclusive Provider Organization (EPO): An Overview
Exclusive Provider Organization (EPO) is a plan where subscribers receive care at a lower rate through a network of medical or healthcare providers (doctors, hospitals). It is not applicable if you use services that are not a part of the EPO network.
How does an EPO plan work?
The EPO is a network of medical specialists who enter into an agreement with the insurer to provide low cost services to the insured. The insured subscribers must use healthcare providers mentioned in the network to receive reimbursements from the insurance company. As such, with EPO, subscribers receive medical care at lower rates than the normal medical charges. It also helps healthcare providers as they receive steady business from EPO subscribers.
How to know if an EPO plan is right for you?
EPO is a good plan but it only works if you use healthcare providers in their network. If you use a hospital outside their network then you and not your insurer are liable to pay some or all medical bills. Some EPO plans may go for partial reimbursements for outside network services in case of emergencies. You can opt for EPO if you are okay with a restricted network of healthcare providers for your medical needs but with the benefit of reduced bills.