What is an out-of-network provider?

An out-of-network provider is a healthcare professional, such as a doctor, hospital, or laboratory, that has not signed a contract with your North Dakota health insurance carrier. These providers do not accept the insurance company’s reimbursement rate for services, nor are their services covered by the insurance company. Because of this, patients are typically responsible for paying the full cost of any services received from an out-of-network provider. When considering out-of-network providers, it is important to understand how your North Dakota health insurance plan’s benefits work. Out-of-network providers often charge more than in-network providers. Generally, your health insurance will pay a portion of these costs and you will be responsible for the remaining balance. It is important to consider if the balance you must pay is worth the cost of the services you receive. In addition to the cost, North Dakota health insurance plans may impose other restrictions when using an out-of-network provider. For example, your plan may require you to pay a higher deductible or percentage of the cost of services. It is important to be aware of these restrictions before deciding to see an out-of-network provider. Although out-of-network providers may offer more convenience and wider selection of services, using them is more expensive than in-network providers. It is important to understand your North Dakota health insurance plan and know what you are responsible for when using out-of-network providers. Doing so can help you make an informed decision about your healthcare options.

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