In-Network vs Out-of-Network Care
What does in-network versus out-of-network mean?
In-network providers have agreed to contracted rates with your plan, so you pay a lower share. Out-of-network providers have not, so you generally pay more — and on some plans, the care is not covered at all outside emergencies.
A network is a set of contracts. When a provider is in network, the price is negotiated in advance and your cost-sharing is based on that negotiated amount.
Networks are specific to a plan, not to a carrier. The same insurance company can offer several plans with meaningfully different networks.
Facility and physician networks can differ. A hospital being in network does not guarantee that every clinician treating you there is.
Important exceptions
- Emergency care is handled differently under most plans and under federal surprise-billing protections.
- Networks change during the year; verify participation directly with the carrier and the provider's office.
- Some plans provide partial out-of-network coverage with a separate deductible and maximum.
Dave's perspective
“Never assume. Confirm the doctor participates in the specific plan you are considering, not just with the insurance company generally.”
Dave Gagleard · Dave Knows Health
Related information
Plan availability, eligibility, benefits, exclusions, underwriting requirements, enrollment periods and coverage vary by carrier, product and state.