Exclusive provider organization

Healthcare in the United States
Government health programs Federal Employees Health Benefits Program (FEHBP) Indian Health Service (IHS) Medicaid / State Health Insurance Assistance Program (SHIP) Medicare Prescription Assistance (SPAP) Military Health System (MHS) / Tricare Children's Health Insurance Program (CHIP) Program of All-Inclusive Care for the Elderly (PACE) Veterans Health Administration (VHA)
Private health coverage Consumer-driven healthcare Flexible spending account (FSA) Health reimbursement account (HRA) Health savings account (HSA) High-deductible health plan (HDHP) Medical savings account (MSA) Private Fee-For-Service (PFFS) Health insurance in the United States Health insurance marketplaces Premium tax credit Managed care (CCP) Exclusive provider organization (EPO) Health maintenance organization (HMO) Preferred provider organization (PPO) Medical underwriting
Health care reform law Emergency Medical Treatment and Active Labor Act (1986) Health Insurance Portability and Accountability Act (1996) Medicare Prescription Drug, Improvement, and Modernization Act (2003) Patient Safety and Quality Improvement Act (2005) Health Information Technology for Economic and Clinical Health Act (2009) Patient Protection and Affordable Care Act (2010)
State level reform Dirigo Health (Maine) Massachusetts health care reform Oregon Health Plan SustiNet (Connecticut) Vermont health care reform
Municipal health coverage Healthcare in California Healthy San Francisco Healthy Way LA My Health LA Fair Share Health Care Act (Maryland) Healthy Howard (Howard Co., Maryland)
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In the United States, an exclusive provider organization (EPO) is a hybrid health insurance plan in which a primary care provider is not necessary, but health care providers must be seen within a predetermined network. Out-of-network care is not provided, and visits require pre-authorization. Doctors are paid as a function of care provided, as opposed to a health maintenance organization (HMO). Also, the payment scheme is usually fee for service, in contrast to HMOs in which the healthcare provider is paid by capitation and receives a monthly fee, regardless of whether the patient is seen.^[1]

History

Exclusive provider plans existed as early as 1983 as a variation of preferred provider plans, which emerged in the early 1980s.^[2]

References

^ Davis, Elizabeth. "EPO Health Insurance—How It Compares to HMOs and PPOs". HealthInsurance.About.com. Archived from the original on March 7, 2014. Retrieved Jan 15, 2014.
^ Katz, Cheryl (June 1983). "Preferred Provider Organizations". Postgraduate Medicine. 73 (6): 143–146. doi:10.1080/00325481.1983.11697868. ISSN 0032-5481.