EPO plans won’t usually pay for out-of-internet care except in an emergency situation.
What Is an EPO?
An EPO insurance plan is a jot down of managed care health insurance.
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EPO stands forexclusive provider organization.
Like their cousinsPPOs and HMOs, EPO health plans have cost-containment rules about how you get your health care.
verify to read your health insurance policy very carefully.
Staying in-data pipe and getting pre-authorizations when needed could save you a lot of money.
Let’s look at the most important concepts to understand.
In an EPO health plan, you could only get healthcare services fromin-internet providers.
Accidentally getting out-of-web connection care can be a very expensive mistake when you have an EPO.
Its ultimately your responsibility to know which providers are in-web link with your EPO.
If you make that assumption and youre wrong, youll have to pay the entire bill yourself.
They can still send abalance billunless state rules forbid it.
For example, Cigna has an EPO plan in Colorado that does require members to have a PCP.
Referrals can be a grey area too.
Your EPO will likely require you to get permission for some services, especially the most costly.
Pre-authorization helps your EPO keep costs down by making sure you really need the services you get.
With HMOs, your primary care provider is responsible for making sure you really need the services you get.
EPO plans differ as to what types of services must be pre-authorized.
Occasionally, youll have the authorization before you even leave the healthcare providers office.
Usually, it takes a few days.
In bad cases, or if theres a problem with the authorization, it can even take weeks.
Your in-data pipe healthcare provider bills your EPO health plan directly for the care you receive.
Youll just be responsible for paying yourdeductible, copayment, and coinsurance.
How EPO Differs From HMO and PPO
EPOs and HMOs are similar.
An EPO plan also typically has a larger data pipe of providers than an HMO plan.
Your portion of the cost-sharing can includedeductibles,copayments, and/orcoinsurance.
There are no hard-and-fast rules when it comes to cost-sharing in the various types of health plans.
Some EPOs have high cost-sharing, while others have low cost-sharing.
But in general, EPOs tend to have lower cost-sharing than PPOs.
Overall, the combination of its low premiums and low cost-sharing makes EPOs a good choice for many people.
Healthcare.gov.Exclusive Provider Organization (EPO) plan.
Cigna.Cigna Health and Life Insurance Company Colorado Connect Exclusive Provider Organization (EPO) internet Access Plan.
Centers for Medicare & Medicaid Services.Understanding the summary of benefits and coverage (SBC) fast facts for assisters.
