CPB Certified Professional Biller Certification Practice Exam

What type of health insurance plan is an EPO?

1. Exclusive provider organization

2. Emergency provider organization

3. Essential provider organization

4. Extended provider organization

The correct answer is: Exclusive provider organization

An EPO, or Exclusive Provider Organization, is a type of health insurance plan that offers a network of healthcare providers from which members can choose, but with the stipulation that they must use these in-network providers to receive coverage for their healthcare needs. This emphasizes that the plan is "exclusive" in nature, meaning that care is generally not covered if provided by out-of-network providers, except in emergencies. EPOs typically do not require members to select a primary care physician or obtain referrals to see specialists, making them more flexible compared to some other managed care plans like Health Maintenance Organizations (HMOs). This can contribute to higher patient satisfaction due to easier access to specialists without the need for prior authorization. The other options, such as Emergency Provider Organization, Essential Provider Organization, and Extended Provider Organization, do not correspond to established insurance plan types recognized in the healthcare industry, reinforcing that "Exclusive Provider Organization" is indeed the correct identification for an EPO.