One fine day, we will all look back at these terms – PPO, HMO, EPO, Deductibles and laugh about how we had to jump through hoops to figure out which coverage to get. For now though, the waters are tricky to navigate – and one has to understand the key differences between PPOs and HMOs (and their hybrid child – the EPO)

 

The Biggest Surprise – Pre-Authorization

Requires Pre-authorization? – This to me, is the DECIDER question – this essentially allows insurance companies to overrule your need for services.  Since I do not trust any insurance company, I like to avoid this pre-authorization – and hence prefer plans without this need. In effect, that limits me to HMOs.

 

 

What’s the Difference Between EPOs, PPOs, and HMOs?
Pays for out-of-network care? No Yes No
Requires pre-authorization? Yes Yes No
Requires a primary care physician who acts as a gatekeeper to access other services? No No Yes
Requires referrals to see a specialist? No No Yes
How are doctors paid by the health plan? Paid only when they provide a service. More services = more $. Paid only when they provide a service. More services = more $. Paid the same amount each month whether they provide lots of services or none.

 

Note that PRE-AUTHORIZATION is different from REFERRALS – in case of referrals, PPOs are more flexible than HMOs. In case of pre-auths however, HMOs win hands down.

Anuj holds professional certifications in Google Cloud, AWS as well as certifications in Docker and App Performance Tools such as New Relic. He specializes in Cloud Security, Data Encryption and Container Technologies.

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Anuj Varma – who has written posts on Anuj Varma, Hands-On Technology Architect, Clean Air Activist.