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 Posted: Mon Mar 29, 2010 11:52 am Post subject: EPOs |
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I've heard about HMOs, PPOs, their advantages and disadvantages. Can anyone tell me more about EPOs?
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Darlac
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| Posted: Tue Mar 30, 2010 5:23 am Post subject: |
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| EPOs are quite similar to that of the HMOs, you may choose a doctor from within their network only. If you're with an EPO, the provider would be paid in return for their services. On the other hand, the HMOs are paid on a monthly basis. |
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steven
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| Posted: Wed Mar 31, 2010 5:55 am Post subject: |
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| See, above all it's very important for you to understand how these EPOs work. First of all, you'd need to go to a doctor who falls within your carrier network. Thereafter, your claims will be filed upon meeting a small co-payment. You'll need to pay your premiums on a monthly basis. |
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roddick
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| Posted: Wed Mar 31, 2010 7:10 am Post subject: |
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I picked an EPO through my company. It is real easy just stay in network and as long as it is a covered service. I love mine, I pay just a copay for services and then it covers at 100%. I had a 15K surgery a few years ago and paid my $250. copay and nothing else. Sometimes it take a little "leg" work to make sure you are going to a doctor in network, but most have on site services to check.
Never take the doctor's office word that they are in network. They may tell you that they will take your insurance, but that does not mean they are in your network.
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Dasfuk
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| Posted: Thu Apr 01, 2010 12:39 am Post subject: |
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Actually, an EPO is a variation of PPO. PPOs allow you to visit any doctor or hospital, in or out of network. EPOs limit you to providers within the network only, except in emergencies.
The difference between EPO and HMO is that in the HMO, you must choose a Primary Care Physician (PCP) and use that physician for most of your care, and to obtain a referral to any specialist. In the EPO, you can go to any provider in the network without the need to have a PCP or a referral.
If you are essentially a healthy person, an EPO might be a better choice of health plan than an HMO. You have to look at what is covered and what your out of pocket costs will be. Especially in the event of a hospitalization.
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MaxHerr
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| Posted: Thu Apr 01, 2010 7:39 am Post subject: |
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Hi everyone, I understand that an EPO might be a cheaper option than an HMO. But, how can I be sure that an EPO would be a better option? Does an EPO cover all that is being covered under an HMO?
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Darlac
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| Posted: Fri Apr 02, 2010 3:43 am Post subject: |
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| Quote: | | Does an EPO cover all that is being covered under an HMO? |
No one here can answer this for you. It really depends on the policies that you are looking at. If it is from your employer, they should have a breakdown of coverage for both to see what they cover, what limits for different treatments...etc. EPO and HMO have nothing to do with what services are covered.
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Dasfuk
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| Posted: Fri Apr 02, 2010 4:32 am Post subject: |
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Max, right on target.
An EPO is nothing more than a PPO that doesn't allow the participant to seek treatment outside of the network of providers. They cannot prevent the participant from going to an non-network provider; they simply won't pay for the treatment. Emergencies are a different story, they have to be covered in or out of network, just like HMOs.
These plans are cheaper than PPOs as they are just another step in managed care. Think of this, sort of, like a HMO with different ideals.
Now here's where I have to disagree with Max a bit. I have seen more than one PPO and EPO require the enrollee to choose a PCP. Not for gatekeeping purposes, but to identify services that are within the network so the patient doesn't HAVE to go out of the network.
For instance, I have a friend that is the most claustrophobic person I have ever seen. She had to have a MRI and was terrified to be (her words) "stuck in that &$(#^% tube for 1/2 hour...I'll go berzerk!! I need an open MRI machine!!" So, she was going to pay out of pocket and go to another provider to get the open MRI instead, but I suggested she call her PCP to see if he could help, and she actually called him! She never does what I tell her, but she's constantly calling me for help. He told her that there was a brand-spankin' new open MRI machine at a network facility and he would be happy to book her an appointment. This saved her more than $1000. Not shabby. The difference was that her PPO primary care physician had no "gatekeeper" authority and couldn't prevent her ("lock the gate") from seeking out of network care. Still would have been covered, but the out of net coverage wasn't nearly as good as in net coverage. Typical PPO.
Finally, PPOs and HMOs emphasize different things. HMOs have traditionally emphasized preventive care, and major medical insurance and PPOs have really emphasized maintenance of a disease. So, by getting HMO coverage, you can normally receive preventive treatments on a very low or even no cost basis. My whole family got both flu shots this year (5 of us) and it didn't cost one cent through our HMO. I have friends that paid $30 a pop for those puppies. I get a physical yearly and it costs me a $10 copay, including all lab tests. My vision exam and glasses/contacts cost me a whopping $10. My PCP is great, takes plenty of time with me, and seeing that I "know the rules," I can get a referral any time I want one to go anywhere I want.
The average person complains about HMOs due to plain ignorance and them not getting what they want immediately. Read the contract- it's just like anything else; if you know the rules you can win the game.
OH YEAH!! I have a minor little rant. I wish people would STOP referring to HMOs and PPOs as "INSURANCE." They are NOT insurance plans or policies. They are health care service contracts, they are NOT insurance. The only INSURANCE out there is Major Medical. Thank you, we now return to your regularly scheduled program.
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InsTeacher
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| Posted: Fri Apr 02, 2010 5:07 am Post subject: |
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It seems an EPO is a good option for those who don't need to visit doctors beyond the EPO network. It could also be a better option for those who're looking for a cheaper health plan.
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anonymous00
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| Posted: Fri Apr 02, 2010 9:25 am Post subject: |
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I find EPOs a bit restrictive in nature. Their doctors-network seems pretty small. You can't just think of visiting a provider (who doesn't fall within the network) without being able to pay for the fees out of pocket.
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Juanita
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| Posted: Sun Apr 17, 2011 1:10 am Post subject: WrRAoLrUnCtryP |
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Insurance epo.. Bang-up 
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| Posted: Sun Apr 17, 2011 1:29 am Post subject: |
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| Quote: | | I find EPOs a bit restrictive in nature. Their doctors-network seems pretty small. You can't just think of visiting a provider (who doesn't fall within the network) |
Well, Juanita, that's the whole purpose of the "E" in EPO. It means "EXCLUSIVE". Providers who are not in the network (except in emergencies) are EXCLUDED from being paid by the insurance company.
EPOs are a variation on the PPO model. You can see any provider in the network, but you cannot go outside the network without prior approval. Most EPO networks are as large as the PPO networks from which they derive. The PPO allows you to go to any provider in or out of the network, but will cost you more outside the network than if you use a network provider.
The advantage of either PPO or EPO over HMO is the ability to freely choose which provider you want to see and when. Specialist, nonspecialist, doesn't require a referral in the PPO/EPO models, as it does in an HMO.
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MaxHerr
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| Posted: Sun Apr 17, 2011 1:42 am Post subject: |
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| Quote: | | OH YEAH!! I have a minor little rant. I wish people would STOP referring to HMOs and PPOs as "INSURANCE." They are NOT insurance plans or policies. They are health care service contracts, they are NOT insurance. The only INSURANCE out there is Major Medical. Thank you, we now return to your regularly scheduled program. |
While this semantic debate/debacle could continue ad nauseum, the distinction as to what is or is not insurance is defined in a state's insurance code. HMOs, PPOs, EPOs, POSs, Major Medical -- they are all regulated under the insurance codes of every state. Which kind of makes them all insurance -- to one degree or another. And, yes, the HMOs and PPOs tend to call their covered persons "subscribers" or "members", not "insureds", further confusing the issue.
California has chosen to primarily regulate the HMOs under a different state agency, the Dept of Managed Health Care (originally the Dept of Corporations), and with additional, parallel laws found in the Health and Safety Code. But that does not remove them entirely from scrutiny by the Insurance Commissioner.
And, on the contrary, all PPOs and EPOs are regulated in California by the Dept of Insurance only. So a company like Wellpoint's Anthem Blue Cross, which offers HMOs, PPOs, and EPOs, finds itself regulated by both the Dept of Insurance and the Dept of Managed Health Care.
So whether you want to call them "service plans" or "insurance", it does not bother me one way or the other. They all "indemnify" us against the financial losses that can attend an illness or injury. And that's the word most closely associated with insurance.
On a side note, the Motor Clubs (AAA, etc) are considered insurance in California, and they must be licensed. Now those companies hawking auto "warranties" . . . (California calls them insurance and regulates them as insurance, and the ones who try to call themselves "service plans, not insurance" -- they get those cute little CEASE & DESIST letters from the Commissioner).
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MaxHerr
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| Posted: Fri Apr 22, 2011 8:02 am Post subject: igGNaorEoKrfqYV |
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Insurance epo.. May I repost it?
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| Posted: Wed May 04, 2011 1:15 pm Post subject: wDPjKbQwQJ |
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Insurance epo.. Nice
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