A cluster of doctors and medical care providers of multiple specialties who are in a contract with the health insurance companies from the health insurance network. These doctors provide health and medical care to the members who are insured under the plan. People avail of the health insurance network provider so that they don't have to go bankrupt at times of severe ailment or emergencies.

Definition of an out-of-network provider

An out-of-network implies that the doctor or the medical facility has no contract with your health insurance plan. They can charge you full price and are generally considered more expensive than the in-network provider.

What are the reasons for the doctor to be not in the insurer's network?

• Some of the doctors aren't in the network because they deny offering the negotiated rates decided by the network providers to the patients.
• At times, the insurer prefers to keep the in-network group small, so that they can build a stronger base for negotiations with the doctors and medical facilities.
• Some of the states have incurred "any willing provider" laws. This law allows health care providers to become members of the network providers if the conditions are met.

How will you know the providers who are out-of-network?

There are network directories maintained by the health insurers. This directory has a list of all the in-network providers. The name which is not on the list is considered to be an out-of-network provider. However, to get more confirmed about them, call the provider directly and check with them if they are in-network with your insurance plan.

Situations where out-of-network provider prove to be a better choice

It has been seen that initially, the out-of-network seems to be much more expensive than the in-network. However, at certain times, you would realize that the out-of-network provider would be beneficial. We have some points below to prove the statement.

At the time of emergency

When there is a health emergency in your family, you are bound to contact the nearest medical facility for the preliminary help. The nearest facility or doctor might not be covered under in-network; however, as you have the out-of-network cover, you can get the medical aid and pay the balance bill if required. Also, as per the "Affordable Care Act," insurers have to treat emergencies as in-network irrespective of the medical facility where the treatment is done.

If you need specialized treatment

Suppose you have a rare disease and there are very few specialists who treat such issues, chances are that they might not come under the in-network provider. In that case, it is better to go for an out-of-network insurance plan, so that at least some portion of your medical bill is insured.

When you are out-of-station and need medical aid

If you fall ill when you are away from home, you might have to contact a medical facility who is out-of-network. This also increases your scope to contact any doctor or medical facility available in the unknown place.

Whenever you plan to buy health insurance, check the network and choose the one that would be suitable for you. The out-of-network ones might be a little costly than the in-network but the benefits might lure you as per your needs.