An Exclusive Provider Organization
- often called an EPO - has some similarities
to a PPO, but there are also some major drawbacks
to the EPO. As a rule, the EPO is a network of
health care professionals who have signed agreements
saying that they will provide specific services
at huge discounts. The idea is to make medical
costs more affordable rather than having the health
care professionals make big bucks from the insurance
companies.
Things to consider before you select an EPO:
- There could be a maximum lifetime cap. For
example, you may be limited to $100,000 in benefits.
If you reach that point, your insurance will
no longer pay - ever. The amount will vary but
a young person who faces a catastrophic illness
that stretches over many years may very reach
that cap amount. That person may then have difficulty
finding another insurance provider because the
illness is then considered a pre-existing
illness.
- Your insurance will probably pay nothing if
you go outside the list of approved health care
providers, and that could very well include
specialists.
- Compare the costs for some specific services
with the EPO, with no insurance, and with another
insurance plan. For example, compare the cost
of a normal office visit to your local doctor,
the cost with the EPO and the cost if you had
some other insurance plan. This will help you
decide if an EPO is right for you and your family.
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