What's an EPO and how does it work?

EPO stands for exclusive provider organization. Now, what does that mean?

It means your health plan provides you with access to a network of high-quality providers who we've worked with to set special prices for you. As a member of an EPO, your health plan only covers care when you see these in-network providers, so you must stay in your network.

What if you go out of network? BridgeSpan won't cover any of your bill. That means you are responsible for 100% of costs (excluding medical emergencies). The exception is in Idaho, where EPO plans cover 10% of out-of-network expenses.

It's important to know who is in your EPO network. You can find an in-network provider easily when you sign in to your BridgeSpan account and search using Find a doctor. When you're signed in, you'll get a list of providers who are in YOUR network.

Avoid unwelcome surprises in your medical bill. Sign in and search for an in-network provider today.

 What is the difference between in-network and out-of-network coverage?

A network is a group of doctors, clinics and other health care providers who have worked with us to set special prices just for you. When a health care provider is in your network, it's called "in network" and BridgeSpan pays for more of the bill. When you go outside your network, it's called "out of network." If you have an EPO, BridgeSpan won't pay any of an out-of-network provider's bill. That means you're responsible for 100% of the costs. One exception is if you live in Idaho, where your EPO plan will cover 10% of out-of-network expenses. Learn more about networks.

 How do I find an in-network provider?

You can find an in-network provider in three easy steps.

  1. Sign in to your BridgeSpan account, or set up an account if you don't have one.
  2. Click Find a doctor.
  3. Search for the type of provider you need. When you sign in, the Find a doctor tool only shows providers that are in your network.
 What if I need care while traveling?

If it's an emergency, go to the nearest emergency room. (ER coverage is the same as if you were in network, but if the ER charges more than our negotiated rate, you may be responsible for the balance of charges.) If you just need a quick consult with a doctor, your health plan covers on-demand telehealth through Doctor on Demand. Telehealth—having a doctor's appointment over the phone or video chat—lets you meet with a doctor wherever and whenever. Doctor on Demand appointments work just like any other visit to the doctor. You get the same confidential consultation and can have a prescription sent to a local pharmacy, if needed. The cost for a telehealth visit is usually less than an in-person appointment. Learn more about how and when to use this convenient benefit.

Note: Some states limit or don't allow telehealth services. Check your Doctor on Demand availability when you request an appointment.

 Do I have to choose a primary care provider (PCP)?

Some EPO plans have an Accountable Health Network (AHN). If yours does, then it's a good idea to choose a PCP because AHNs work best when you have a primary care provider in your corner to coordinate all your care. Examples of primary care providers are those practicing family medicine, internal medicine or naturopathy.