What is PPO, HMO, EPO, POS? what are network providers?

 Today I would like to explain the network types most commonly known as EPO’s, PPO’s, HMO’s and POS plans. Some plan types allow you to use almost any doctor or health care facility. Others limit your choices or charge you more if you use providers outside their network. You can easily identify the type of plan by looking at the description next to the plan name. 

Let’s look at each network type. http://www.SFCheapInsurance.com

·         Preferred Provider Organization (PPO): PPOs give you the choice of getting care from in network or out-of-network providers. You pay less if you use providers that belong to the plan’s network. You’ll pay more if you use doctors, providers, and hospitals outside of the network, and you may have higher out-of-pocket costs for services. If you have a PPO plan, you can visit any doctor without getting a referral.

·         Exclusive Provider Organization (EPO): A managed care plan where services are covered only if you use doctors, specialists, or hospitals in the plan’s network (except in an emergency). No referral is required to see a specialist

·         Point of Service (POS): A type of plan where you pay less if you use doctors, hospitals, and other health care providers that belong to the plan’s network. POS plans require you to get a referral from your primary care doctor in order to see a specialist.

·         Health Maintenance Organization (HMO): A type of health insurance plan that usually limits coverage to care from doctors who work for or contract with the HMO. An HMO generally won’t cover or has limited coverage for out-of-network care except in an emergency. If you use a doctor or facility that isn’t in the HMO’s network, you may have to pay the full cost of the services you get. HMO members usually have a primary care doctor and must get referrals to see specialists.

We’ve been talking so much about provider networks, SO what is that?

Well, a provider network is a list of the doctors, other health care providers, and hospitals that a plan has contracted with to provide medical care to its members. These providers are called “network providers” or “in-network providers.” A provider that hasn’t contracted with the plan is called an “out-of-network provider.”