By; Edwin L Crammer, CPA – In order to keep the costs of insurance down for those who are about to sign up for the Affordable Care Act, otherwise known as “Obamacare”, they created a new type of insurance not available before. The new type of insurance is known as “EPO Insurance” the “E” stands for Exclusive.
This insurance is a hybrid type of insurance that is between a HMO and a PPO policy and as such is considered to be cheaper than an HMO. By being cheaper it has more restrictions other than what is available in the two types of policies listed above.
It really is designed for individuals who are relatively healthy as you will see why You are placed into a group of doctors who have agreed to take a lower payment for their services, which probably means the doctor you have been going to over the past few years is not one of them. You still have a co-payment to be paid to the doctor when you visit the one you have chosen and still will have to meet a deductible as stated each year on your policy.
The kicker is that if you need to see a specialist, your doctor does not have to refer you out to a specialist, but either way, your insurance does not cover the cost of that specialist as there are very few in the plan. Therefore, you are on the hook for that specialists entire bill and that can be expensive.
Because the doctors who will be in your group and be the one you choose as your personal doctor has agreed to accept a smaller fee for treating you. Those doctors who choose to go that route will probably not be the most experienced doctors out there. In addition, in order to be able to make a decent living due to the lower income from each patient, the doctors who agree to this arrangement are not going to spend much time with you. The reason being that they will have to see as many patients as possible during the time that they have office hours and in addition, you may have to wait weeks just to get an appointment.
So think carefully by agreeing to sign up for an “EPO” all of the literature out there for the consumption of potential policyholders, do not explain these limitations clearly.
To contact Edwin L. Crammer CPA. e-mail at: Ed@www.eyeonsouthflorida.com