In the United States, an exclusive provider organization (EPO) is a hybrid health insurance plan in which a primary care provider is not necessary, but health care providers must be seen within a predetermined network. Out-of-network care is not provided, and visits require pre-authorization. Doctors are paid as a function of care provided, as opposed to a health maintenance organization (HMO). Also, the payment scheme is usually fee for service, in contrast to HMOs in which the healthcare provider is paid by capitation and receives a monthly fee, regardless of whether the patient is seen.[1]
History
editExclusive provider plans existed as early as 1983 as a variation of preferred provider plans, which emerged in the early 1980s.[2]
See also
editReferences
edit- ^ Davis, Elizabeth. "EPO Health Insurance—How It Compares to HMOs and PPOs". HealthInsurance.About.com. Archived from the original on March 7, 2014. Retrieved Jan 15, 2014.
- ^ Katz, Cheryl (June 1983). "Preferred Provider Organizations". Postgraduate Medicine. 73 (6): 143–146. doi:10.1080/00325481.1983.11697868. ISSN 0032-5481.