reimbursement: exclusive provider organization (EPO)
EPO's are similar to PPO's in their organization and
purpose. Unlike PPO's, however, EPO's limit their beneficiaries to participating providers for their health care
services. In other words, beneficiaries covered by an EPO are required to receive
all of their covered services from providers that participate in the EPO, similar
to an HMO. The EPO does not cover services received from
other providers. Some EPO's parallel HMO's in that they not
only require exclusive use of the EPO provider network, but also use a "gatekeeper" approach to authorize non-primary care services.*
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*Extracted from Family Physicians
and Managed Care: A View to the 90's: (paperback 1993) with permission from American Academy of Family Physicians
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