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What Does Out-Of-Network Mean In My Health Insurance?

Understanding "out-of-network" in health insurance is crucial for managing costs. This guide clarifies the term, explaining that out-of-network providers lack agreements with your insurer for discounted rates.

  • 05 Jan 2024
  • 3 min read

One term that often confuses people in health insurance is “out-of-network”. An out-of-network provider is any healthcare provider or hospital that has yet to sign a contract with your insurance company agreeing to the discounted rates of the insurance agreement. We’ll help you understand this concept a bit better in the next section.


What Does Out-Of-Network Mean In Health Insurance 


Let us first understand the meaning of in-network providers before we understand out-of-network providers. An in-network healthcare provider is one that has agreed to accept discounted rates from your insurance company. Let’s say a healthcare provider charges you ₹5000 for a certain treatment, but your plan only covers ₹4500. An in-network healthcare provider is not allowed to bill you for the difference. Now, you may be wondering, “What if my doctor is out of network?” If your plan covers out-of-network care, the insurer may pay some amount of the bills, but you'll still be responsible for paying the rest. And if your plan doesn't cover out-of-network care or you haven't met your out-of-network cost-sharing, you'll have to pay the entire amount.


In certain situations, choosing an out-of-network healthcare provider is necessary and smart, even if it initially costs more. However, in certain conditions, an in-network provider is necessary, especially in cases of emergency. In such urgent conditions, your insurance plan will cover the expenses the same as for in-network healthcare.


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To sum it up, out-of-network refers to any healthcare provider or facility that is not within your insurance network. This can lead to higher out-of-pocket costs, but it also gives you the freedom to choose a wider range of providers.

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