Exclusive Provider Organization (EPO) - Health Insurance Definition

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.