What is Blue Cross EPO?

Asked by: Stephan Considine IV  |  Last update: February 11, 2022
Score: 4.5/5 (17 votes)

An Exclusive Provider Organization is designed for integration of a healthcare plan, health providers and an insurance company. ... An EPO plan often covers services in-network with network providers and has $0 benefits for out-of-network.

What is the difference between Blue Cross EPO and PPO?

A PPO offers more flexibility with limited coverage or reimbursement for out-of-network providers. An EPO is more restrictive, with less coverage or reimbursement for out-of-network providers. For budget-friendly members, the cost of an EPO is typically lower than a PPO.

What is a Blue Cross EPO plan?

EPO (Exclusive Provider Organization) plan

With the exception of emergency services, there are no benefits for members who choose to receive services outside of the preferred provider network. Members do not need to select a primary care provider or get referrals from a primary care provider to see a specialist.

Is Blue Cross Blue Shield an EPO?

Welcome to Blue Shield's Exclusive Provider Organization (EPO) Plan. ... Blue Shield of California has a statewide network of physician members and contracted hospitals known as Preferred Providers.

What is an EPO insurance plan?

A managed care plan where services are covered only if you go to doctors, specialists, or hospitals in the plan's network (except in an emergency).

Blue Cross and Blue Shield | Health care system | Heatlh & Medicine | Khan Academy

38 related questions found

Does EPO cover out of state?

EPO stands for "Exclusive Provider Organization" plan. As a member of an EPO, you can use the doctors and hospitals within the EPO network, but cannot go outside the network for care.

Is EPO a good plan?

EPO health plans generally have lower monthly premiums, co-pays, and deductibles than non-EPO options. ... If you want the freedom to schedule appointments directly with specialists, and do not mind having to switch health care providers to one in your EPO network, then EPOs may be a good choice for you.

What is national PPO EPO?

The EPO (Exclusive Provider Organization) plan delivers in-network-only benefits through the national BlueCard® PPO network. ... EPO members must seek care from participating BlueCard PPO providers, except in the case of a life- or limb-threatening emergency.

What is the difference between an EPO and an HMO?

An EPO (or “exclusive provider organization”) is a bit like a hybrid of an HMO and a PPO. EPOs generally offer a little more flexibility than an HMO and are generally a bit less pricey than a PPO. ... But like an HMO, you are responsible for paying out-of-pocket if you seek care from a doctor outside your plan's network.

What is the difference between EPO and POS?

What is the difference between an EPO and POS? POS and EPO plans both don't require provider referrals to see specialists, but here's how they're different: POS plans let you get out-of-network care; EPO plans do not. POS requires that you choose a primary care provider while EPOs don't.

Why is EPO more expensive than PPO?

Exclusive Provider Organization. Has a network of healthcare providers that it works with exclusively. ... EPOs are usually cheaper than PPOs due to the restrictions on which healthcare providers you can visit. See also Coinsurance vs Copay.

Do I need a referral with an EPO?

Most EPOs will not require you to get a referral from a primary care healthcare provider before seeing a specialist. This makes it easier to see a specialist since you're making the decision yourself, but you need to be very careful that you're seeing only specialists that are in-network with your EPO.

Do doctors prefer HMO or PPO?

PPOs Usually Win on Choice and Flexibility

If flexibility and choice are important to you, a PPO plan could be the better choice. Unlike most HMO health plans, you won't likely need to select a primary care physician, and you won't usually need a referral from that physician to see a specialist.

How do I know if my insurance is HMO or PPO?

The biggest differences between an HMO and a PPO plan are: Patients in with an HMO must always first see their primary care physician (PCP). If your PCP can't treat the problem, they will refer you to an in-network specialist. With a PPO plan, you can see a specialist without a referral.

What is the difference between Delta Dental PPO and EPO?

EPO stands for exclusive provider organization, and doesn't cover any out-of-network care. A Blue Dental EPO plan only covers services from in-network PPO dentists. ... If you want the freedom to see dentists outside our preferred network, a PPO plan could be best for you.

Can you get a PPO through marketplace?

Yes. Any plan shown in the Marketplace includes these essential health benefits. This is true for all plan categories (all “metal levels,” including Catastrophic plans) and all plan types (like HMO and PPO).

Are EPO plans self funded?

EPO plans usually have the lowest premiums or self-funded plan costs.

What does it mean 10 coinsurance after deductible?

Coinsurance is an additional cost that some health care plans require policy holders to pay after the deductible is met. ... For instance, with 10 percent coinsurance and a $2,000 deductible, you would owe $2,800 on a $10,000 operation – $2,000 for the deductible and then $800 for the coinsurance on the remaining $8000.

How do I find out my deductible?

A deductible can be either a specific dollar amount or a percentage of the total amount of insurance on a policy. The amount is established by the terms of your coverage and can be found on the declarations (or front) page of standard homeowners and auto insurance policies.

Can you have health insurance in two states?

You can only buy multi-state health insurance plans through the ACA's, or Obamacare's, state-based and federally facilitated health insurance exchanges. They are not available in the private marketplace.

Can I use my Medicaid in a different state?

Can I use my Medicaid coverage in any state? A: No. Because each state has its own Medicaid eligibility requirements, you can't just transfer coverage from one state to another, nor can you use your coverage when you're temporarily visiting another state, unless you need emergency health care.

Why would a person choose a PPO over an HMO?

Advantages of PPO plans

A PPO plan can be a better choice compared with an HMO if you need flexibility in which health care providers you see. More flexibility to use providers both in-network and out-of-network. You can usually visit specialists without a referral, including out-of-network specialists.

What does PPO not cover?

PPOs cannot charge more than Original Medicare charges for certain kinds of care, including chemotherapy, dialysis, and skilled nursing facility (SNF) care. However, PPOs can charge higher copays for other services, including home health, durable medical equipment (DME), and inpatient hospital care.

Can I have both HMO and PPO?

Yes, you can have two health insurance plans. Having two health insurance plans is perfectly legal, and many people have multiple health insurance policies under certain circumstances.

Can I switch from HMO to PPO?

Contact your insurance agent or see your company human resources representative to discuss your health insurance coverage. Ask about the next available enrollment period and find out if you must wait until then to change health insurance coverage from your HMO to a PPO.