What is the difference between HMO, PPO and EPO?

September 29th, 2017 | Categories: General

Health Maintenance Organizations (HMO) plans only cover care that is provided by doctors and hospitals within the HMO’s network. With an HMO plan, a member selects a Primary Care Physician for all their health care services. With the exception of emergency services, all referrals must come from the member’s Primary Care Physician.

Preferred Provider Organizations (PPO) plans cover care that is provided both inside and outside the plan’s provider network. Members have the freedom of seeing any provider without a referral, whether they are inside or outside they’re network. Often times, a member may pay a higher percentage of out of pocket costs for out-of-network care.

Exclusive Provider Organizations (EPO) plans only provide coverage to care that is within the plan’s provider network. Within an EPO plan, a member does not need to choose a primary care physician and does not need a referral to see a specialist. An EPO plan has a limited network of doctors and hospitals to chose from and does not cover care outside of that network.

Book your complimentary consultation with Dr. Zelken today. Call us at (949) 432 – 4730. It is Dr. Zelken’s utmost pleasure to consult with you, whatever your insurance company may be. Here at Z Plastic Surgery, we are happy to work with you and your insurance company by filing all the all the necessary paperwork. We contact your insurance in real-time to obtain eligibility information and maximize your benefits.

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