Thursday, July 10, 2014

Health Insurance Network Differences HMO, EPO, and PPO

Health Insurance is confusing and what is with all of the acronyms? HMO, EPO, PPO etc?

Well here are some answers:

Different companies are known for different "Networks" or groups of doctors. Here is a break down of these three types of Health Insurance Companies. There are more types out there, but these are the largest and most common types.

HMO: This stands for Health Maintenance Organization. The largest example of this type is Kaiser Permanente, but there are others like Western Health Advantage and even some of the big players like Anthem and Health Net have created HMO's of their own.

This type of provider is more restrictive than the other types. For example, there is only coverage for seeing "out of network providers" in the event of an emergency. So, other than emergencies you are required to go to "in network" doctors and facilities. Also, if you want to see a specialist, you must receive a referral from your primary doctor. Sometimes getting a referral is simple, but other times it is more of a pain where you must visit your primary doctor then visit the specialist essentially paying for two visits when all you needed was one.

EPO: This stands for Exclusive Provider Organization. This is a fairly new type that Blue Shield is using more than other carriers. It is a bit of a hybrid between an HMO and a PPO. Like an HMO you must stay in network, unless it is an emergency and at that point you can go to the nearest emergency room whether or not it is in network. However, more like a PPO you don't need to get referrals to see a specialist.

PPO: This stands for Preferred Provider Organization. This by far accounts for the majority of the health insurance policies. This type of health insurance allows for clients to see "Out of Network Providers" and still receive some coverage. They may pay more to go out of network, but there is still some coverage. Also, you don't have to get a referral to see a specialist.

Check out this info graphic for a quick reference guide:

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