Many health plans list an amount that is the most they'll pay for a certain service received out-of-network. If your doctor's bill is higher than what your plan will pay, you might have to pay the difference. And rates may be higher than the discounted in-network rate. When health insurers don't have a contracted relationship with out-of-network doctors and facilities, they can't control what is charged for services. It's usually much higher than the in-network discounted rate. If a doctor or facility has no contract with your health plan, they're considered out-of-network and can charge you full price. These health care providers are considered in-network. These doctors and facilities must meet certain credentialing requirements and agree to accept a discounted rate for covered services under the health plan in order to be part of the network. To help you save money, most health plans provide access to a network of doctors, facilities, and pharmacies. What's the difference between in-network and out-of-network? Know the difference between in-network and out-of-network care to help save on health care expenses. Certain choices you make can affect what you'll pay out of pocket. You can avoid unexpected medical bills by knowing how your plan works.
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