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By Dr. David Edward Marcinko MBA MEd CMP™
SPONSOR: http://www.CertifiedMedicalPlanner.org
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What does in-network mean?
In-network refers to a health care provider that has a contract with your health plan to provide health care services to its plan members at a pre-negotiated rate. Because of this relationship, you pay a lower cost-sharing when you receive services from an in-network doctor.
What does out-of-network mean?
Out-of-network refers to a health care provider who does not have a contract with your health insurance plan. If you use an out-of-network provider, health care services could cost more since the provider doesn’t have a pre-negotiated rate with your health plan. Or, depending on your health plan, the health care services may not be covered at all.
CITE: https://www.r2library.com/Resource/Title/0826102549
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OUT OF NETWORK [OON] MEDICAL CARE
Classic: Any medical provider, supplier or facility that is in-network is one that has contracted with your health insurer to provide services;as above.
Modern: Depending on your plan, if you visit an out-of-network provider, it may not be covered or might be only partially covered. When making appointments with various doctors and service providers, you may notice some are listed as “in-network” while others are “out-of-network.”
THINK: Medicare Advantage {Part C] Plans
Example: You can expect a higher deductible and out-of-pocket limit at out-of-network providers. Your coinsurance and co-payment may also be higher for out-of-network providers.
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Filed under: Accounting, CMP Program, Glossary Terms, Health Economics, Health Insurance, Health Law & Policy, Healthcare Finance, iMBA, Inc., Managed Care, Touring with Marcinko | Tagged: health, Health Insurance, healthcare, HMO, iMBA, in network, insurance, Marcinko, medicare, Medicare Advantage, Medicare C, OON, out of network, PPO | Leave a comment »
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