What is an out-of-network provider?

An out-of-network provider is a health care provider that is not part of a health insurance plan’s network of contracted providers. Depending on the type of health care coverage you have, out-of-network providers may not be covered or may be covered at a reduced rate. In Arizona, health care providers are classified as in-network or out-of-network. In-network providers have a contract with your health insurance plan that determines how the plan will pay for services. Out-of-network providers, on the other hand, do not have a contract with your health insurance company, so the company does not have to pay for or provide coverage for services from out-of-network providers. It’s important to know if your provider is an in-network or out-of-network provider, as this can affect your out-of-pocket costs. If you receive services from an out-of-network provider, you may be responsible for more of the cost due to the lack of an agreement with your health insurance plan. You should contact your health insurance provider to find out if the provider you’re considering is in-network or out-of-network.

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