EPO (Exclusive Provider Organization) insurance refers to a type of medical insurance that only covers you if you use a doctor or healthcare facility within their network. There is no need for a PCP (Primary Care Physician) like you would be required to have with other types of policies.
How EPO Insurance Works
When you go with this type of medical insurance, it’s important that you’re aware that any treatment you receive out of their designated network won’t be covered. This means that you’ll be solely responsible for paying the bill yourself. EPO insurance companies have created a network that consists of every aspect of healthcare to ensure that this is something those that they cover can follow.
There are exceptions, such as during complex treatments, true emergency situations, and if they don’t have a provider in their network that can give you the treatment you need. Just make sure you communicate with your insurance company right out the gate to ensure that there are no surprises.
The Advantages of EPO Insurance
Since it’s always best to be aware of what a certain type of insurance has to offer before making a final decision, the top three benefits of EPO insurance policies have been covered below.
· Having a primary care physician is not a requirement.
Sure, it’s highly recommended to have a PCP but this might not always be the most convenient requirement to follow in certain situations. Since EPOs handle all their treatment within their network, there are no strict rules on having a primary doctor.
· Monthly premiums are usually quite a bit lower.
This is because their network has allowed them to fine-tune their expense when it comes to paying for medical treatment. While you are a little bit more restricted since you have to stay within their network, you have the opportunity to save money each month.
· There is no requirement to get a referral to see specialists.
Again, this benefit is provided due to their usage of a network that they have built for those that they provide coverage for. Insurance companies offering this type of policy have taken the time to include every type of treatment you can think of within their network, eliminating the need to get a referral to see a specialist which also saves a lot of time.
If you have no problem staying within the pre-defined network of hospitals and providers set forth by your EPO insurance provider, you could unlock some great benefits. However, if flexibility is critical when it comes to where you get medical care, you might consider an HMO or HDHP.