I've heard about HMOs, PPOs, their advantages and disadvantages. Can anyone tell me more about EPOs?
Total Comments: 16
Posted: Sun Apr 17, 2011 01:29 am Post Subject:
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.
Posted: Sun Apr 17, 2011 01:42 am Post Subject:
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).
Posted: Fri Apr 22, 2011 08:02 am Post Subject: igGNaorEoKrfqYV
Insurance epo.. May I repost it? :)
Posted: Wed May 04, 2011 01:15 pm Post Subject: wDPjKbQwQJ
Insurance epo.. Nice :)
Posted: Fri Jun 03, 2011 02:08 am Post Subject: zUUsllaBRl
Insurance epo.. Peachy :)
Posted: Fri Jun 03, 2011 06:22 am Post Subject: yvWeNhySoEY
Posted: Sun Apr 17, 2011 01:29 am Post Subject:
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.
Posted: Sun Apr 17, 2011 01:42 am Post Subject:
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).
Posted: Fri Apr 22, 2011 08:02 am Post Subject: igGNaorEoKrfqYV
Insurance epo.. May I repost it? :)
Posted: Wed May 04, 2011 01:15 pm Post Subject: wDPjKbQwQJ
Insurance epo.. Nice :)
Posted: Fri Jun 03, 2011 02:08 am Post Subject: zUUsllaBRl
Insurance epo.. Peachy :)
Posted: Fri Jun 03, 2011 06:22 am Post Subject: yvWeNhySoEY
Insurance epo.. Great idea :)
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