An EPO is a type of low-cost insurance plan that provides affordable health care for you and your family. EPO stands for Exclusive Provider Organization. EPO health insurance plans are extremely economical and offer low monthly premiums and low cost-sharing plans.
If you are an EPO plan member, you will have access to all of the hospitals and doctors within the program. Hospitals and doctors outside of the program will not be able to provide you with care (except for in an emergency) unless you pay out of pocket. Any expenses from within the network will be reimbursed guaranteed.
There are several health insurance carriers and plans designed for different needs. With EPO health insurance you can see a specialist without a referral so you can get specialty care faster. You are not obligated to choose a primary care physician so you can get by without one. There is no limit on maximum lifetime coverage. Therefore, if you get extremely sick your insurance won’t cut off after a certain amount and you do not have to be pre-authorized before using certain services.
The only services that may need authorization before use are hospitalization, surgeries, procedures, expensive treatments and medications, MRI’s, CT scans and home medical equipment like an oxygen mask. Your EPO physician would most likely take the initiative to get you preauthorization for these services. Although your doctor may do this for you, the responsibility of getting pre-authorization is yours.
If you do not have pre-authorization before using these services, your EPO will not cover it even if it was medically necessary for you to use them. There is no current documentation on if EPO health insurance programs offer specific pharmacy discounts for prescription medicines. However, Pharmacy Coupons offers presription drug discounts and coupons that can be used for at any pharmacy accross the country. These Pharmacy Coupons discounts will work for EPO plan members for a variety of prescriptions drugs and prescription drug refills.