Which term denotes a health plan that covers only in-network providers?

Which term denotes a health plan that covers only in-network providers?

• A. Blue Cross and Blue Shield
• B. Exclusive Provider Organizations (EPOs)
• C. Fee-For-Service Payment
• D. DRGs

Answer: (B)

Exclusivity of provider networks is the defining feature here. Exclusive Provider Organizations restrict coverage to providers within their contracted network, with little to no coverage for out-of-network care except in emergencies. This setup helps control costs by directing members to a specific set of providers, and you typically don’t need referrals to see in-network specialists. If you go outside the network, the plan usually won’t cover the expense. Think of the other terms as not describing a network restriction: Blue Cross and Blue Shield is a broad payer brand that can include various plan types; Fee-for-Service refers to how providers are paid rather than which providers are covered; DRGs are a hospital payment method based on diagnosis groups, not a network design.

Exclusivity of provider networks is the defining feature here. Exclusive Provider Organizations restrict coverage to providers within their contracted network, with little to no coverage for out-of-network care except in emergencies. This setup helps control costs by directing members to a specific set of providers, and you typically don’t need referrals to see in-network specialists. If you go outside the network, the plan usually won’t cover the expense.

Think of the other terms as not describing a network restriction: Blue Cross and Blue Shield is a broad payer brand that can include various plan types; Fee-for-Service refers to how providers are paid rather than which providers are covered; DRGs are a hospital payment method based on diagnosis groups, not a network design.