EPO and PPO are two popular health insurance plans available in the USA. As prices of health care services are escalating all the time, it is prudent to get yourself medically insured with one or the other plan. It is important to choose a health plan after considering its features, benefits and drawbacks which is why it is necessary to compare the two plans.
PPO stands for Preferred Provider Organization that allows a person to choose any physician in the network. Here the patient has to pay for the medical treatment and then request for reimbursement later. However, there is no restriction on getting treatment outside the network but then the patient may have to bear some part of the expenses involved.
In EPO, which stands for Exclusive Provider Organization, it is binding upon the patient to select a physician from the network if he intends to avail all the benefits outlined in the plan.
Difference between EPO and PPO
Both EPO and PPO have different features and it is necessary to keep in mind various factors such as cost, options as well as your own needs before finally choosing a plan. Let us see the two plans closely. You must identify your own needs before going with a plan. The price of an insurance policy is of course important, but you have to see the coverage as well as the conveniences that you can avail using a plan. Check on all the features and benefits before asking for a quote for a health insurance plan.
PPO’s are usually run by a team of doctors and health care organizations that charge a premium for their services from the customers and provide them with a third party insurance. EPO’s work along similar lines though they are more cost effective as they provide more discounts to the customers.
PPO seems to be more flexible as a patient does not need recommendation of their primary health care provider to see a physician in the network. The fee of specialists is slightly higher than that in EPO, though.
In the case of an EPO, the company recommends the specialist and the patient has no option but to follow the prescription and advice given by such a specialist.