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Health Care Reform:

Health Insurance & Affordable Care Act

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Out-of-network, also called out-of-plan or non-preferred provider

Most health plans have a list of doctors, hospitals, and other providers that have agreed to participate in the plan’s network. Providers in the network have a contract with your plan to care for its members at a certain cost. You pay less for medical services when you use one of the providers on this list.

If you see a doctor or use a hospital that does not participate with your health plan, you are going out-of-network. You usually have to pay more for out-of-network care. Some plans won’t cover any amount of out-of-network care. Some cover a percentage of care.

 

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