One of the most confusing types of insurance providers is known as a Exclusive Provider Plan (often abbreviated to the acronym EPO).

When working with patients in a Medical Office, there are many different types of Insurance options. Each type of insurance has it’s own set of advantages and disadvantages, and it is important to understand these so you can assist your patients when they are using their insurance.

An Exclusive Provider Plan is a type of managed care health insurance. Patients using an EPO will receive their health care exclusively from health care providers the EPO contracts with or the EPO won’t pay for the care.

You can think of PPOs, HMOs and EPOs as cousins. Each of these health plans have cost-containment rules about how patients can receive their health care.

Exclusive provider organization plans (EPOs) Exclusive provider organization (EPO) plans are similar to HMO plans in that

An Exclusive Provider Plan’s rules center around two basic cost-containment techniques:

1) Where and from whom you get health care services is limited to providers that the EPO has negotiated discounts with. They typically require the patient to choose a primary care physician.

2) Health care services are limited to things that are medically necessary or that make your health care costs lower in the long run, like preventive care.

They also require referrals if the services of a specialist are necessary, and the specialists must also be an Exclusive Provider Plan network-contracted provider. The only exception is in the event of an emergency when a network provider is unavailable.

On the plus side for patients, cost-sharing like deductibles, copayments, and coinsurance are kept to a minimum with an Exclusive Provider Plan.

In fact, some EPOs don’t require any deductible or coinsurance at all, and just charge a small copayment at the time of service. Because of its low cost-sharing and low premiums, an Exclusive Provider Plan is one of the most economical health insurance choices.