In / Out-of-Network

If you are considering or have health insurance with a managed care providers such as HMO, POS, or PPO, then you probably have heard of the terms in-network and out-of-network.

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

An in-network provider is contracted with a managed health insurer to provide services to plan members for a rate that has already been negotiated. An out-of-network provider is not contracted with your health insurance plan.

If you visit a healthcare provider within your network, the amount you pay will be significantly less than what you would pay to an out-of-network one.

Every insurance company has different rules but in most cases, they will pay far less or nothing at all for services you receive from an out-of-network provider.