Q:

What is an EPO health plan?

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Quick Answer

An EPO is a type of managed care health insurance that requires the holder to use only the providers on the company's list. If he fails to do this, the EPO does not pay for the medical services, states About.com. The acronym "EPO" stands for "exclusive provider organization."

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Full Answer

When using a medical provider, About.com states that inadvertently using care that is out of the network can be a very costly mistake. To avoid paying the entire cost for the health care received, it is the insurance holder's responsibility to make sure prior to receiving the services that the health care provider, including the lab and imaging service used, is a part of the network. If the EPO does not have a provider for a service that the holder needs, pre-arranging and notifying the EPO can prevent the need to pay the bill out of pocket. An EPO does, however, pay for the cost of emergency care if the insurance holder must go to the nearest emergency room that is not in-network.

An EPO requires its members to get permission for some health services before it pays for the services, notes About.com. Most EPO plans require pre-authorization for services such as MRI and CT scans, hospitalizations, medical equipment, surgeries and expensive prescription medicines.

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