Exclusive Provider Organization (EPO)

Also called: EPO

An exclusive provider organization is a plan that covers care only from providers in its network, much like an HMO, but often does not require referrals to see specialists. Step outside the network and you generally pay the full cost yourself, except in emergencies. Knowing your plan is an EPO helps you anticipate that out-of-network denials will be hard to overturn on network grounds alone.

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Disclaimer: This definition is provided for general educational purposes only and is not legal, medical, or insurance advice. Insurance rules, deadlines, and terminology vary by plan, state, and over time. Always check your own plan documents and confirm current details before acting.