Monthly Archives: June 2011

Preferred Provider Organization (PPO) and Exclusive Provider Organization (EPO)

PPO’s are groups of hospitals and/or physicians who create contractual agreements with payers to offer a specified set of health care services under pre-determined financial arrangements. EPO’s are like PPO’s in their purpose, though EPO’s limit their recipients to participating … Continue reading

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HMO (Health Maintenance Organization) Overview and List of Wisconsin HMO’s.

The term HMO stands for Health Maintenance Organization, meaning a health plan that provides prepaid health coverage for hospitals and physicians. Members of an HMO health insurance plan are required to use specified providers that participate in the plan. They are also enrolled for specific periods of time.

HMO common provisions:

1. Members are able to choose a primary care physician (PCP) that is part of a contracted provider network.

2. A co-payment is paid to the physician and/or hospital at the time of service by the HMO member.Continue reading

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