In-network and out-of-network providers, what is the difference?

An in-network provider is contracted with the health insurance organization and grants services to plan members for rates that have been agreed-upon previously. An out-of-network provider is also contracted with the insurance carrier however the pre-negotiated rate is higher. If you visit a doctor or other type of provider within the network, the amount you will be responsible for paying will be less than if you go to an out-of-network provider. However, in many cases there are exceptions to this. For instance, the insurance company can either pay less or not pay at all for services received from out-of-network providers. Normally, PPO, POS and HMO plans make use of provider networks.

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