Health Insurance

19 Types of Health Insurance Exclusive Provider Organizations (EPOs) For more information on comparing PPOs, HMOs and EPO’s, see pages 21–22. Which doctors, hospitals, and other providers can I use? You must use providers in the EPO network. • Generally, you do not have to use a primary care doctor. • You must use providers in the EPO network. • Most of the time, you do not need to get referrals to see specialists who are in-network. • EPOs can have many limits on the doctors or hospitals you can use. • With an EPO, you can use the doctors and hospitals within the EPO’s network. However, you cannot go outside the network for covered care. • If you do go out-of-network, your EPO will not pay for any services. The only exception is if you have an emergency or urgent care situation. What are my costs if I have an EPO? Costs can vary. It depends on the providers you see. If you stay in the EPO’s preferred provider network, your costs are less because you will be reimbursed for the health care you get. Like PPOs, you pay a co-pay or percentage of every medical bill up to a certain amount. If you decide to see a doctor outside the EPO network, you must pay for the full medical bill. Where can I go if I have a problem? If you have an EPO, or are not sure who to call, contact the Department of Insurance at 800-927-4357 for help. In some cases, the Department of Managed Health Care (DMHC) handles EPOs. For those, you will need to contact DMHC for help at 888-466-2219 .