What is an out-of-network provider?

An out-of-network provider is a type of health care provider who does not have a contract with your health insurance company. These providers may include specialists, such as dermatologists or surgeons, or primary care providers, such as family physicians or pediatricians. In Washington, if you receive care from an out-of-network provider, you may need to pay more for services than you would if you went to an in-network provider. In some cases, you may need to pay the entire bill up front. Your health insurance company may also require you to pay an additional fee for seeking out-of-network care. However, if you have an emergency, you may be able to receive care from an out-of-network provider without having to pay extra. In addition, if you are unable to find an in-network provider close to you, you may be able to receive care from an out-of-network provider without incurring additional fees. It is important to review your health insurance plan carefully to determine whether you will be responsible for any out-of-network costs.

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