What is the difference between an in-network
and an out-of-network medical provider ?
An in-network medical provider
is within the approved network of providers for a particular health plan.
Out-of-network providers are not on the list. If you visit a doctor within
the network, the amount you will be responsible for paying will be less
than if you go to an out-of-network doctor. In many cases, the insurance
company will not pay anything for services your receive from outside their
network; however, there are exception to this.
As a general rule, HMOs tend
to have smaller provider networks than PPOs. In HMO and PPO plans, referrals
to specialists will be to doctors within the network. Indemnity plans
typically do not have networks; you go to whatever doctor you want.
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