Paul Sanchez
Out-of-network refers to a healthcare provider who does not have a contract with your health insurance plan. If you use an out-of-network provider, healthcare services could cost more since the provider doesn’t have a pre-negotiated rate with your health plan. Or, depending on your health plan, the healthcare services may not be covered at all.
| Characteristics | Values |
|---|---|
| Network | In-network |
| Contract | Signed |
| Negotiated rates | Agreed upon |
| Cost | Less |
| Balance bill | No |
| Network | Out-of-network |
| Contract | Not signed |
| Negotiated rates | Not accepted |
| Cost | More |
| Balance bill | Yes |
What You'll Learn
- Out-of-network healthcare providers do not have a contract with your health insurance plan
- Out-of-network healthcare providers do not accept negotiated rates from the insurance company
- Out-of-network healthcare providers can balance bill patients for the remainder of the charges
- Out-of-network healthcare providers can be more expensive than in-network healthcare providers
- Out-of-network healthcare providers can be found using the Find a Doctor tool
Out-of-network healthcare providers do not have a contract with your health insurance plan
If you use an out-of-network provider, healthcare services could cost more since the provider doesn’t have a pre-negotiated rate with your health plan. Or, depending on your health plan, the healthcare services may not be covered at all.
Out-of-network providers can and do balance bill patients for the remainder of the charges after the insurance company has paid its share. In-network providers have agreed to accept the insurance company's payment (plus the patient's pre-determined cost-sharing amount) as payment in full, but out-of-network providers have not signed any sort of agreement with the insurer.
The No Surprises Act protects patients from surprise balance bills in emergencies or situations where the patient unknowingly received care from an out-of-network provider while at an in-network facility.
Providers that are out-of-network are those that do not participate in that health plan's network. This means that patients will typically pay more or the full amount for the service they receive.
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Out-of-network healthcare providers do not accept negotiated rates from the insurance company
Out-of-network providers can and do balance bill patients for the remainder of the charges after the insurance company has paid its share. In-network providers have agreed to accept the insurance company's payment (plus the patient's pre-determined cost-sharing amount) as payment in full, but out-of-network providers have not signed any sort of agreement with the insurer.
The No Surprises Act protects patients from surprise balance bills in emergencies or situations where the patient unknowingly received care from an out-of-network provider while at an in-network facility.
Providers that are out-of-network are those that do not participate in that health plan's network. The provider is not contracted with the health insurance plan to accept negotiated rates. This means that patients will typically pay more or the full amount for the service they receive.
Use the Find a Doctor tool and start searching! Enter your location and health plan, and your search will return results that only include providers who are in your network.
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Out-of-network healthcare providers can balance bill patients for the remainder of the charges
When a healthcare provider is out-of-network, it means that they do not have a contract with your health insurance plan. This can lead to higher costs for patients as the provider does not have a pre-negotiated rate with your health plan. The insurance company may not cover the healthcare services at all.
Out-of-network providers can balance bill patients for the remainder of the charges after the insurance company has paid its share. In-network providers have agreed to accept the insurance company's payment (plus the patient's pre-determined cost-sharing amount) as payment in full. However, out-of-network providers have not signed any sort of agreement with the insurer.
The No Surprises Act protects patients from surprise balance bills in emergencies or situations where the patient unknowingly received care from an out-of-network provider while at an in-network facility.
Providers that are out-of-network are those that do not participate in that health plan's network. The provider is not contracted with the health insurance plan to accept negotiated rates. This means that patients will typically pay more or the full amount for the service they receive.
Use the Find a Doctor tool and start searching! Enter your location and health plan, and your search will return results that only include providers who are in your network.
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Out-of-network healthcare providers can be more expensive than in-network healthcare providers
Out-of-network healthcare providers are those that do not participate in a health plan's provider network. This means that the provider has not signed a contract agreeing to accept the insurer's negotiated prices.
In-network healthcare providers are those that participate in a health plan's provider network. This means that the provider has signed a contract agreeing to accept the insurer's negotiated prices.
When a patient uses an out-of-network healthcare provider, the healthcare services could cost more since the provider doesn’t have a pre-negotiated rate with the health plan. Or, depending on the health plan, the healthcare services may not be covered at all.
In-network healthcare providers have contracted with the health insurance, which sets the costs associated with all the medical services they provide. Because the health insurance company and the primary care provider have agreed upon certain rates, you will normally pay less when using in-network health care. This can ultimately help you lower your medical costs. And because the rates are contracted, your doctor cannot charge you more than the pre-negotiated rate.
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Out-of-network healthcare providers can be found using the Find a Doctor tool
Out-of-network healthcare providers are those that do not participate in a health plan's provider network. This means that the provider has not signed a contract agreeing to accept the insurer's negotiated prices.
If you use an out-of-network provider, health care services could cost more since the provider doesn’t have a pre-negotiated rate with your health plan. Or, depending on your health plan, the health care services may not be covered at all.
However, the No Surprises Act protects patients from surprise balance bills in emergencies or situations where the patient unknowingly received care from an out-of-network provider while at an in-network facility.
To find out-of-network healthcare providers, you can use the Find a Doctor tool. Enter your location and health plan, and your search will return results that only include providers who are in your network.
You can also search for in-network providers using the Find a Doctor tool. This can help you lower your medical costs as in-network doctors have contracted with your health insurance, which sets the costs associated with all the medical services they provide.
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Frequently asked questions
Out-of-network refers to a healthcare provider who does not have a contract with your health insurance plan.
Using an out-of-network provider can be more expensive as the provider doesn't have a pre-negotiated rate with your health plan.
In-network providers have a contractual agreement with the health plan, accepting negotiated rates for services, and typically result in lower costs for patients. Out-of-network providers do not have this agreement, and patients may have to pay the full amount for services.
