What is an out-of-network provider?

An out-of-network provider is a healthcare provider who does not have a contractual relationship with an insurance company. Out-of-network providers are not considered in-network providers and are not covered by most insurance plans. This means that, if you use an out-of-network provider, you will typically be responsible for more costs than if you use an in-network provider. Out-of-network providers can be health care providers such as doctors, hospitals, and laboratories, among others. In California, health insurance law requires that insurance companies provide coverage for out-of-network services, but there are usually higher costs for using out-of-network providers. Usually, if you are enrolled in a health plan and you get care from an out-of-network provider, the health plan is only required to pay a portion of the cost of the services received. The remaining costs are your responsibility. It is important to understand that not all health care providers or services are in-network and some providers may charge more than an in-network provider. You should also be aware that different insurance plans have different rules regarding out-of-network providers and some plans may not cover out-of-network services at all. Be sure to check with your insurance provider before using an out-of-network provider to make sure that you understand the costs associated with using an out-of-network provider.

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What is an out-of-network provider?

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