Below are some of the acronyms explained to help you in choosing your health plan.
Preferred Provider Organization (PPO) – A PPO plan allows you to see a specialist without seeing your primary care provider first. This is called self-authorization. You may use in-network providers for your care which generally cost less, or providers not signed up with your network who generally carry higher out of pocket charges. Out of network providers will not usually provide all of the benefits your in-network providers do. You may also be balance billed which means you will pay the difference in cost your plan does not cover.
Health Maintenance Organization (HMO) – An HMO plan is based on the concept of having a “gatekeeper.” The gatekeeper is your primary care physician who must give you a referral prior to seeing a specialist and also authorize that referral. The primary care physician is also a specialist. There are no out of network benefits except for emergency services and the HMO is not responsible for processing or paying claims outside of their network.
Exclusive Provider Organization (EPO) – An EPO plan is like a mixture of a PPO plan and an HMO plan. Like a PPO, an EPO plan member does not require authorization from a PCP to see a specialist. However, like an HMO, an EPO plan member does not have out of network benefits, except for emergency services.
Hopefully this will help in the understanding of acronyms in an industry full of them.