EPO health care plans refer to health and dental care programs offered by Exclusive Provider Organizations. An Exclusive Provider Organization refers to a network of health and dental care providers who have entered into a contract with the insurance company maintaining the said EPO network. The company came up with this offer so that consumers looking for health and dental care assistance will sign up with them.
In an EPO plan, the insurance provider will reimburse any expense incurred by a subscriber when the subscriber seeks dental care services from a dental care provider who is part of the EPO network. No reimbursements will be made to subscribers who goes to a dentist from outside of the EPO network. Dental care providers find it beneficial to enter into a contract with an EPO network because they will have more patients, who are subscribers of the network, come in.
Find out more about how this health care coverage option works so you can also consider it when making your decisions.
Understand EPO Health Care Plans and How You Can Benefit from Them
- How can you get the benefits of EPO plans?
- How much will you pay for dental care under an EPO?
- Which procedures are covered?
1. How can you get the benefits of EPO plans?
If you need a dental care insurance plan, you can consider getting an EPO dental plan. An EPO dental plan is a plan that reimburses you for your dental expenses when you go to participating dentists. This is the one rule you can’t break if you want to enjoy the benefits of Exclusive Provider Organization plans. By complying with this rule, you can cut your dental care expenses by a large margin. There are only a few very special cases where an EPO plan provided coverage for a service not provided by a network dentist, and mostly such cases involves emergency care.
2. How much will you pay for dental care under an EPO?
So you now know that an EPO plan can help reduce the cost of your dental care procedures. But do you know just how this plan can really help you save? The EPO network provider enters into an agreement with network dentists to provide lower rates to members like you. The lower the rate the company is able to negotiate with the dentists, the lower the premiums you will have to pay for your EPO plan. This also means you can get good rates even with a good co-payment arrangement, mostly an arrangement which requires you to pay as low as $30.
EPO plans also promise that it can reimburse you for your costs at a higher percentage than PPO plans can. Just remember, reimbursements are only given when you go to participating dentists because these are the only dentists who have agreed to honor your special privileges.
3. Which procedures are covered?
EPO health care plans can be very reliable in terms of reimbursements, the number of dentists you can visit, EPO customer claims services, and so on. But one problem with this is that the procedures you can get reimbursements for are pretty limited. This is because most EPO plans do not reimburse for specialist care. This includes almost all the major and the most expensive dental procedures you might need including root canals, dental implants, braces, and gum health care. These procedures are often too costly so EPO plans do not really reimburse at high percentages for such procedures. EPO plans also do not reimburse expenses incurred for cosmetic dental procedures.
So basically, an EPO plan is ideal for those who want a basic dental care plan they can rely on to help them afford regular dental care, especially the routine and basic preventive services. This shows that EPO plans are more focused on ensuring that everyone gets preventive dental care on the premise that prevention is better than seeking treatment.
The Primary Care Provider Setup in EPO Health Care Plans
There is yet another unique feature about EPO health care plans. This feature, however, is one thing it has in common with an HMO plan. EPO plans require members to choose one care provider from the EPO network. That provider will be the member’s primary care provider, and the primary care provider will be in charge of overseeing the general health and dental care of the said member. If the treatment necessary requires a specialist, the primary provider will issue a referral. This just shows that EPO health care plans are focused on continuous and basic dental health care maintenance.