You may have a good understanding of what it means if your health insurance is part of an HMO, or part of a PPO. Those are the two most well known kinds of health insurance. They are not the only options, however. There is also EPO health insurance.
What is an EPO? It stands for Exclusive Provider Organization. It consists of a network of doctors and health care providers, who have been contracted by an insurance company to provide care to the people who have signed up with the EPO for a reduced cost. So far, this sounds a lot like a PPO (Preferred Provider Organization). They are not the same. With a PPO, if you choose to visit a doctor who is outside of the network, you will be expected to pay for the cost of the visit yourself. After that, you can submit a claim form to your insurance company, and wait to see if they will reimburse you. With an EPO, if you visit a doctor who is out of network, you will be expected to pay for it yourself. Your insurance company will not even consider reimbursing you.
There are benefits to using an EPO. It provides you with medical care for a discounted price, so long as you choose to stay within the network. You can be certain that your medical expenses will remain low, and that your insurance company will cover everything, so long the medical care came from a doctor or provider that is part of the network. You also have the flexibility to visit doctors that are outside of the network, if you want to, without losing your EPO insurance as a result. (Just be prepared to pay for the entire cost out of pocket). This can be reasurring for people who have concerns that a health insurance company will have control over your treatments options, or if you are fearful of having to leave the doctor of your choice and being required to select another doctor who is in the network.
There are also disadvantages that come with using an EPO. If you need to see a specialist for a disease, chronic condition, or disorder, and that specialist isn’t part of the network, the EPO will not cover any of the cost for that medical care. You will have to pay all those bills yourself. EPO networks are much smaller than the networks that a PPO or HMO has access to. This limits the kind of health care that your EPO insurance will cover for you. It also means that you will have a smaller selection of doctors to choose from. If you have an emergency, and get taken to a hospital that is out of the network, the EPO will not cover any of those medical bills, either.