What does the Exclusive Provider Organization (EPO) insurance model restrict?

The Exclusive Provider Organization (EPO) insurance model primarily restricts coverage for out-of-network providers. Under this model, members are required to use a network of healthcare providers for their medical services, which means that unless a service is performed by an in-network provider, it will not be covered by the insurance plan. This emphasizes the exclusivity of the provider network in managing costs and patient care, allowing the insurer to negotiate better rates with specific providers.

The EPO model can offer flexibility in terms of not requiring referrals to see specialists, which differentiates it from some other managed care models. However, the trade-off is that members do not have reimbursement options if they choose to see out-of-network providers, making it critical for individuals in an EPO plan to stay within their designated network to avoid significant out-of-pocket expenses.