exclusive provider organization


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Related to exclusive provider organization: preferred provider organization

ex·clu·sive pro·vid·er or·gan·i·za·tion (EPO),

(eks-klū'siv prō-vīd'ĕr ōr'gan-i-zā'shŭn),
A managed care plan in which enrollees must receive their care from affiliated providers; treatment provided outside the approved network must be paid for by the patients.
See also: managed care.

Exclusive Provider Organization (EPO)

a type of managed health care organization in which no coverage is typically provided for services received outside the EPO. However, some EPOs incorporate the primary care physician gatekeeper concept along with prospective approval of referrals to specialists of providers outside the EPO.

exclusive provider organization

Managed care A managed care organization similar to a PPO–preferred provider organization in purpose and organization, which allows a Pt to go outside the network for care, but must pay the full cost of the services received; it is similar to an HMO in that primary care physicians act as gatekeepers to a network of other providers, an authorization system, etc. See Gatekeeper, HMO, Managed care organization, PPO.

ex·clu·sive pro·vid·er or·gan·i·za·tion

(EPO) (eks-klū'siv prŏ-vī'dĕr ōr'găn-ī-zā'shŭn)
A managed care plan in the U.S. in which enrollees must receive their care from affiliated providers; treatment provided outside the approved network must be paid for by the patients.
See also: managed care

ex·clu·sive pro·vid·er or·gan·i·za·tion

(EPO) (eks-klū'siv prŏ-vī'dĕr ōr'găn-ī-zā'shŭn)
A managed care plan in the U.S. in which enrollees must receive their care from affiliated providers; treatment provided outside the approved network must be paid for by the patients.
See also: managed care

exclusive provider organization (EPO),

n a dental benefits plan that provides benefits only if care is rendered by institutional and professional providers with whom the plan contracts (with some exceptions for emergency and out-of-area services).
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References in periodicals archive ?
Health Maintenance Organization(HMO) enrollment remains very low among Texas employers, at less than 1% in 2013, and participation in Indemnity, Point-of-Service and Exclusive Provider Organizations will drop precipitously and account for less than 6% of total covered lives.
Four UPMC Inside Advantage plans are available - two preferred provider organizations (PPOs), for small and mid-sized companies; and two exclusive provider organizations (EPOs), for small and mid-sized companies.
For example, Exclusive Provider Organizations were more expensive on average ($4,411 in total costs), but their year-over-year enrollment increased from 12 to 21 percent when offered.
Fee For Service and Exclusive Provider Organizations now virtually disappeared from the market, and HMOs are losing ground as employers seek to help contain the rising cost of health care and insurance premiums.
Oxford's commercial insured products and services include traditional health maintenance organizations, preferred and exclusive provider organizations, point-of-service plans and consumer-directed health plans.