Exclusive provider organization

In the United States, an exclusive provider organization (EPO) is a hybrid health insurance plan in which a primary care provider is not necessary, but health care providers must be seen within a predetermined network. Out-of-network care is not provided, and visits require pre-authorization. Doctors are paid as a function of care provided, as opposed to a health maintenance organization (HMO). Also, the payment scheme is usually fee for service, in contrast to HMOs in which the healthcare provider is paid by capitation and receives a monthly fee, regardless of whether the patient is seen.[1]

Health care in the United States
Government Health Programs
Private health coverage
Health care reform law
State level reform
Municipal health coverage

History

Exclusive provider plans existed as early as 1983 as a variation of preferred provider plans, which emerged in the early 1980s.[2]

See also

References
  1. Davis, Elizabeth. "EPO Health Insurance—How It Compares to HMOs and PPOs". HealthInsurance.About.com. Retrieved Jan 15, 2014.
  2. Katz, Cheryl (June 1983). "Preferred Provider Organizations". Postgraduate Medicine. 73 (6): 143–146. doi:10.1080/00325481.1983.11697868. ISSN 0032-5481.
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