The short answer
In-network providers have a contract with your health plan to accept negotiated rates, so you pay less when you see them. Out-of-network providers have no such contract, so your plan may cover less or nothing, and you can owe much more, sometimes the full charge. The difference can be dramatic, which is why checking whether a provider is in your plan's network before getting care is important. Some plans cover no out-of-network care except emergencies, while others cover it at a higher cost to you.
So in-network providers cost you less through negotiated rates, while out-of-network care can cost much more or not be covered.
Why the cost gap is so large
With an in-network provider, your plan has negotiated a rate and you pay your normal cost-sharing. With an out-of-network provider, the plan may pay a smaller share or none, and the provider can bill you for the difference between their charge and what the plan allows, called balance billing in some cases. This can leave you with a large bill. Our guide to checking your doctor's network status covers verifying before care, and our glossary defines the terms.
The gap comes from negotiated rates in-network versus no contract and possible balance billing out-of-network.
How to protect yourself
Confirm a provider is in your plan's network before scheduling care, understand whether your plan covers any out-of-network care and at what cost, and know that certain protections may apply to surprise out-of-network bills in specific situations. For plans with no out-of-network coverage, staying in-network except in emergencies is essential. Our glossary covers related terms. This is educational information.
The takeaway: in-network care costs less through negotiated rates, while out-of-network care can be far more expensive, so verify a provider's network status before getting care.
Frequently Asked Questions
What is the difference between in-network and out-of-network?
In-network providers contract with your plan to accept negotiated rates, so you pay less. Out-of-network providers have no such contract, so your plan may cover less or nothing and you can owe much more.
Why does out-of-network care cost more?
Your plan may pay a smaller share or none, and the provider can bill you for the difference between their charge and what the plan allows, potentially leaving you with a large bill.
How do I avoid high out-of-network costs?
Confirm a provider is in your plan's network before scheduling care, understand your plan's out-of-network coverage, and stay in-network except for emergencies, especially on plans with no out-of-network benefits.
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