Monday, April 12, 2010

Difference between PPO and EPO




PPO vs EPO

Definition

PPO stands for Preferred Provider Organization, or Preferred Provider Option.

EPO stands for Exclusive Provider Organization.


There are many insurance systems created all over the world to try and make sure that people get their medical treatments at very reasonable rates. It is difficult to predict when you are going to get sick and when you are going to need medical attention, and it is therefore very important to be properly insured. However, due to the overwhelming possibilities available, trying to figure out which one is the best, and how they function, is not easy. For example, let’s look at the systems in the United States – the PPO and EPO insurances.
Technical Differences· A Preferred Provider Organization is run by Medical Doctors, Medical Health providers and other health care organizations that take an insurance premium from the customers and provides them with an insurance policy through a third party organization.
· An Exclusive Provider Organization provides the same kind of insurance plans, however, on a smaller scale. The providers that work with them offer larger amounts of discount for their services.
What does it mean for the patient?
· In the case of a Preferred Provider Organization, people have more flexibility when it comes to choosing the primary care doctor of their choice. Also, they do not need to contact their doctor to get an appointment with a specialist health provider. The fees for the insurance premium is higher than that of the EPO, however, it is only by a very limited margin.
· With an Exclusive Provider Organization the company will choose the primary health care provider for you, and you will have to follow his advice and instructions. It is only when that specific doctor agrees to some kind of treatment that you will be able to get the insurance necessary. The fees are not negotiable, and if you decide to stop the insurance process you will have to pay all the pending bills that the company may have with you.
There is very little difference between the two systems, and it becomes extremely difficult for people to really understand the real meaning of the two of them, however, it is important to study their differences properly.
Summary:
1. A PPO and EPO are medical insurances that are being run by a third party, or an organization.
2. PPO has a vast network of professional providers that function as per their rules and regulations.
3. EPO is a much smaller network, and it does not have so many health care providers.
HMO vs EPO
HMO and EPO are both health insurance schemes. HMO stands for Health Maintenance Organization, and EPO stands for Exclusive Provider Organization. Well, there are several technical differences between HMO and EPO.
When considering their difference, the HMO can be termed as an insured product, which means that the insurance company will pay the costs of the claim. On the other hand, the EPO can be termed as a self-insured product, where the employer has to pay the costs.
In terms of flexibility, the Exclusive Provider Organization is more flexible than the Health Maintenance Organization. In the case of Health Maintenance Organization insurance, a referral from the Primary Care Physician is required. It is the PCP who manages all the medical services and provides referrals. On the contrary, for Exclusive Provider Organization insurance, there is no need for a referral from a Primary Care Physician.
An HMO also requires that the insured person stay within the network of the providers. This is the same with EPO insurance, therefore, there is no out of network coverage for both insurance schemes.
An HMO plan generally has a vast network of doctors, whereas the EPO has only a limited network of doctors.
When comparing the premiums, the EPO has a lower premium than the HMO. The HMO is determined on a capitated basis, whereas the EPO is based on the services provided. When considering their coverage, the EPO is better suited for the rural areas.
The Health Maintenance Organization is regulated under the HMO laws and regulations. The Employee Retirement Income Security Act regulates the Exclusive Provider Organization.
Summary:
1. The Exclusive Provider Organization is more flexible than the Health Maintenance Organization.
2. In the case of Health Maintenance Organisation insurance, a referral from the Primary Care Physician is required. A referral from a Primary Care Physician is not needed for EPO insurance.
3. HMO can be termed as an insured product, which means that the insurance company will pay the costs of the claim. EPO can be termed as a self-insured product, where the employer has to pay the costs.
4. When comparing the premiums, the EPO has a lower premium than the HMO.
5. The Health Maintenance Organization plan generally has a vast network of doctors, whereas the Exclusive Provider Organization has only a limited network of doctors.
6. Unlike the HMO, the EPO is better suited for the rural areas.

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