Blue Dental PPO plans work the same way:. EPO stands for exclusive provider organization, and doesn't cover any out-of-network care. This reduces costs, so your monthly payments will be lower.
The more a plan pays for out-of-network care, the higher your monthly payments will be. If you go out of network, you could be charged for the difference between what we pay and what your dentist charges. That's called balance billing. If you want the freedom to see dentists outside our preferred network, a PPO plan could be best for you.
Want to know if a dentist is in our network? See How do I find a dentist? Which dentist you choose determines how much you'll pay for services. When you get medical care, you and your plan share the cost, beginning with a deductible.
That's the amount you pay for services before your plan begins to pay. After you pay your deductible, you'll have coinsurance and copays. Your coinsurance is usually figured as a percentage of the amount we allow to be charged for services. A copay is a fixed amount you pay for a service, usually when you receive the service. When you have a Blue Dental plan, there are no copays for dental care.
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Sign in to myuhc. Sign in to Medicare member site Sign in to another secure site. Understanding provider networks. What are provider networks? Why do health insurance companies provide access to networks? What are the different kinds of networks? Preapprovals for medical services You may need to get advanced approval before having certain medical services performed, but in an HMO, in many cases that preapproval will be handled through your PCP, if you have one.
Did you know PPO plans overview Want to see someone in-network? Preapprovals for medical services Almost every network requires preapprovals for some medical services, and in a PPO, because you have more freedom to choose where to go and who to see, you may face more preapprovals. And to learn more about these plans and all other health plan types, contact The Olson Group, today!
No related posts. Do I need a primary care physician? Often , but not always. An EPO generally requires you to have a primary care doctor but varies from plan to plan. You can select any doctor you choose, but you will pay more for out-of-network care. Do I need a referral to see a specialist? PPOs are usually more expensive because they are more flexible in allowing you to seek treatment outside of their network of preferred providers.
The cost of a PPO plan will also increase the more often you take advantage of that freedom, as you are expected to cover a higher proportion of the costs incurred in seeing healthcare providers from outside the network.
EPOs are usually cheaper due to the restrictions on which healthcare providers you can visit. Keep in mind that if you visit a healthcare provider from outside your EPO's network, you will almost certainly have to pay the full cost of any treatment.
In both cases, expect to have to contribute at least a small sum towards any medical treatment, including visits to your doctor.
Both EPO and PPO plans usually require you to make a small payment to receive treatment from a provider within the network. This payment is known as a "copayment" when it is a fixed cost and "coinsurance" when it is a percentage of the total cost; it is a payment on top of any monthly premium costs.
See also Coinsurance vs Copay. In an EPO plan, you must also pay the full expense of any treatment received from a healthcare provider outside the network. In a PPO plan, treatment received from outside the network is partially covered by the insurer, but you can expect to pay more than if you stay within the network. These additional fees are said to be included in the plans to ensure people do not take advantage of the system by visiting their healthcare providers more often than necessary.
However, you are free to develop a relationship with a doctor of your choosing, although additional costs will apply if the doctor you choose to see is outside of your network. In other words, you must contact your insurance company before undergoing any major treatment to ask them to authorize the work. If you do not do this, the insurance company will not be liable to pay, even if the treatment can be shown to be medically necessary. Often, your doctor will offer to arrange this pre-authorization for you, but it remains your responsibility to ensure that authorization has been given before beginning the treatment.
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