What is an exclusive provider organization of an HMO?

Answer 1

An Exclusive Provider Oraganization (EPO) is a network of individual medical care providers, or groups of medical care providers, who have entered into written agreements with an insurer to provide health insurance to subscribers. In EPO, medical care providers enter a mutually beneficial relationship with an insurer. The insurer reimburses an insured subscriber only if the medical expenses are derived form the designated netword of medcal care providers. The established network of medical care providers in turn provide subscribed patients medical services at significantly lower rates than what would have been under normal circumstances. In exchange for reduced rates of medical services, medical are providers get a steady stream of business. An EPO earns additional money by charging an access fee ot the insurer for use of the network. It also negotiates with the medical care providers of the organization in order to set fee schedules and help resolve altercations between the insurer and medical care providers. Sometimes EPOs even contact with one another to strengthen their businesses and positions in a certain geographic area. The beneficial relationship between medical care providers and the insurer often rubs off of the insured subscriber because lower rates of medical services means lower rates of increase in monthly premiums. Although a good deal, The downside of EPO is that it can be quite restrictive. As a member of an EPO< you can use the doctors and hospitals within the EPO network, but cannot go outside of the network for care. Suppose you go to a hospital outside of te network in the case of an emergency, you may have to pay your medical bills partially or completely out of the pocket.