What is it called when you need to visit a healthcare provider that is not covered by your insurance plan?

When you visit a healthcare provider that is not covered by your insurance plan, this situation is referred to as being out-of-network. Insurance plans often have a network of preferred providers, which are typically facilities or professionals that have contractual agreements with the insurance company to provide services at negotiated rates. Visiting an out-of-network provider can lead to higher costs because the insurance may not cover the expenses fully, or may not cover them at all, unlike a visit to an in-network provider.

In contrast, being in-network means that the provider does have an agreement with the insurance to offer services at a lower cost to the insured individual. A preferred provider specifically refers to those in-network providers that the insurance company encourages its members to use. A deductible is a specific amount that you pay out-of-pocket for healthcare services before your insurance begins to pay. Understanding these terms helps in navigating healthcare plans and managing costs effectively.