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A PPO is a Preferred Provider Organization. Usually, it works like this: The insurance company provides a list of health-care providers who are in its network. If you use one of them, you pay a nominal co-payment, much as you would with an HMO. The doctor agrees to accept whatever the insurance company gives him (or her). If you go OUTSIDE the network, however, you will have to pay a co-insurance, usually a percentage of the doctor's fee, subject to deductibles. So, if you go outside the network and the doctor or lab charges you $1000 and you have a 20-percent co-insurance, you're going to pay $200, assuming you've already met your deductible.

An HMO is a Health Maintenance Organization. When you go to the doctor, you pay a nominal co-payment. Your care is delivered within a group of connected providers, which is helpful if you are not able to keep track of various medications or condition (Medicare patients as an example). Typically, HMO is integrated and patient focused - PPO and other type networks can be fragmented where providers do not directly communicate with each other about the patient and care delivered. POS means Point of Service. It's just like going out of network in the PPO above.

2010-11-03 18:35:46
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What is the Difference between and epo and hmo in insurance?

EPO stands for "Exclusive Provider Organization." EPO plans may or may not differ very much from HMO (Health Maintenance Organization) plans. It's sometimes hard to make precise distinctions between these types of health plans since the definitions have changed a bit over the years. Generally speaking, however, as a member of an EPO plan, you can only use the doctors and hospitals within the EPO provider network, but cannot go outside of the network for care. There are no out-of-network benefits. This may be the same with some HMO plans. But while an HMO plan will typically require you to coordinate most of your care through a primary care physician (who then refers you to specialists when needed), an EPO plan may allow you more freedom to decide which doctors you see within the provider network. Work with a licensed health insurance agent to help you find the best type of coverage for your needs.


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EPO members do not receive any reimbursement or benefit if they choose to visit medical care providers outside of the designated doctors and hospitals within the established network. Unlike EPO members, however, PPO members are reimbursed for using medical care providers outside of the designated doctors and hospitals.


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