Medical In-Network vs Out-of-Network (OON)
In-Network
Out-of-Network
Providers have agreed to accept discounted rates for covered services that cannot be exceeded.
There are no discounted rates for covered service. Providers can charge full price.
Rates
Cost sharing is available through copays, lower coinsurance %, deductibles and OOP maximums.
There are no copays, and you will be responsible for a higher coinsurance %, deductibles and OOP maximums. You will be responsible for filing your OON claim for potential reimbursement.
Cost
Claims are filed by your provider.
Claims
For emergency services , as defined by your plan documents, plans are legally required to process claims and member responsibility at in-network rates.
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