In-Network
An in-network provider has an agreement with your insurance company. Because of that agreement, your insurance usually pays a larger portion of the bill, and your out-of-pocket costs are often lower.
Out-of-Network
An out-of-network provider does not have an agreement with your insurance company. Your insurance may still help pay for services, but the amount they cover and what you pay can be different.
Being out-of-network does not automatically mean a service isn’t covered. It simply means your benefits work differently. Some families pay for services at the time of the visit and then submit a claim to their insurance company for possible reimbursement. Others may need to meet a separate out-of-network deductible first.
A good question to ask your insurance company before your first appointment is:
“Does my plan include out-of-network benefits, and what can I expect to pay?”
Your provider’s office may also be able to help you understand how your benefits work.
This information is for general educational purposes only. Every insurance plan is different, and your specific benefits will depend on your individual policy.