PPO

HMO vs. PPO vs. EPO: Understanding Plan Types in Eligibility Checks

Maria, a front-desk coordinator, is on her third call of the morning with an insurance company. A patient is waiting for confirmation on whether their specialist visit is covered. The patient’s plan says “EPO,” but Maria isn’t sure if it works like a PPO or an HMO. Meanwhile, the waiting room is filling up. Phones are ringing. Frustration builds.Sound familiar? Insurance plan types—HMO, PPO, and EPO—are more than just acronyms. They directly impact eligibility checks, referrals, and reimbursement. If you