An Exclusive Provider Organization (EPO) is a type of health insurance plan that offers a network of doctors and hospitals. Members must use these in-network providers for their healthcare services, except in emergencies. This structure helps keep costs lower, as the insurance company negotiates rates with the providers.
Unlike other plans, EPOs do not require referrals to see specialists, giving members more flexibility in choosing their healthcare providers within the network. However, if members choose to go outside the network for care, they typically have to pay the full cost out of pocket, making it essential to understand the network options available.