What does an Exclusive Provider Organization (EPO) rely on?

An Exclusive Provider Organization (EPO) primarily relies on a network of affiliated healthcare providers to deliver medical care. Members of an EPO are required to use the doctors and hospitals that are part of this network for non-emergency services. This structure helps to keep costs lower, as the EPO negotiates rates and ensures that care is provided by a specific group of providers. If a member chooses to seek care outside of this network, they typically will not receive any coverage for those services, except in the case of emergencies.

The focus on using affiliated providers allows EPOs to streamline the care process, providing a structured approach where the quality and costs of care can be managed more effectively. This is a fundamental characteristic that distinguishes EPOs from other types of managed care plans, such as PPOs, which offer broader options for seeing non-network providers—albeit often at higher out-of-pocket costs.