• ranavain

    You have a paragraph called “Just what is an EPO?” that doesn’t explain what an EPO is. :)

    When I was managing benefits, one of the main differences I saw between PPO plans and POS/HMO plans was network size. POS plans are, in my experience, usually local networks, or perhaps statewide. PPO networks are much more likely to be national networks. So, organizations that have employees working in many states may find that a PPO plan is a better all-around solution, or may find that having separate HMO plans for each area controls costs better.

    (Of course, that’s not always true, because it’s as you say… insurers can define this stuff however they want!)

    • http://tlnt.com John Hollon

      From the article:

      Exclusive provider organizations (EPOs) are a lot like HMOs: They generally don’t cover care outside the plan’s provider network. Members, however, may not need a referral to see a specialist.

      And this:

      “People have no idea what an EPO is,” says Jerry Flanagan, lead staff attorney at Consumer Watchdog, an advocacy organization that recently filed a class action lawsuit against Anthem Blue Cross in California. They claim, among other things, that the insurer enrolled people in EPO plans with no out-of-network coverage who believed they were being enrolled in PPO plans that provided such coverage.

      “Materials at the time of enrollment and in member’s Explanation of Benefits have clearly stated that the plan was an EPO plan which may not have out-of-network benefits,” said Darrel Ng, a spokesperson for Anthem Blue Cross, in a statement.

      • ranavain

        Well, thanks for the copy/paste, I was just remarking that the section on “Just what is an EPO?” didn’t have a particular explanation, so perhaps a different heading would be better. The explanation provided doesn’t tell the difference between an HMO and an EPO, other than that it’s somewhat less likely that an EPO will require a specialist referral (though it clearly states that both kinds of plans may or may not).

        It’s one of those cases where perhaps giving an example of each kind of plan, or examples of companies, might be more useful. But, you know, thanks for taking the time out to be kind of a jerk about it.