out-of-network

adjective Referring to a provider/service that is not part of a managed care organisation’s network of contracted providers/services.

out-of-network

Managed care adjective Referring to a provider/service that is not part of an MCO's network of contracted providers/services. See Managed care organization.

out-of-network

Pert. to a health care provider or service that is not a part of an individual's health insurance plan. Most health insurers do not pay for services that are provided out of network. The recipient must pay for these services out of his or her own funds.

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References in periodicals archive ?

Emergency services: The bill would ensure that a patient is only required to pay the in-network cost-sharing amount required by their health plan for emergency services, regardless of them being treated at an out-of-network facility or by an out-of-network provider.

United States : Carper Joins Delaware Patient Advocates to Discuss Bipartisan Bill to End Surprise Medical Bills

Balance billing occurs when consumers get care or medical supplies from out-of-network healthcare providers, such as doctors, hospitals, or labs.

OPIC Highlights Insurance Consumer Protections from Texas 2019 Legislative Session

TUESDAY, July 2, 2019 (HealthDay News) -- Eighteen percent of all emergency department visits and 16 percent of in-network hospital stays have at least one out-of-network charge, according to a report published June 20 by the Kaiser Family Foundation.

Considerable Number of Patients Receive Surprise Hospital Charges; 18 percent of all ED visits, 16 percent of in-network hospital stays have at least one out-of-network charge

* Although 77 percent of surveyed providers acknowledge the value of in-network referrals, 79 percent still make out-of-network referrals.

REVENUE IN REFERRALS

1895 is protections to end so-called "surprise bills" that occur when patients receive medical services from out-of-network health care professionals at in-network hospitals.

Surprise-billing legislation passes Senate committee

When patients are treated by these out-of-network providers, they can be billed at "list prices," which are typically many times higher than what any insurer would pay.

Testimony on the Lower Health Care Costs Act

With T-Mobile MONEY, there are no fees -- no monthly, overdraft or transfer fees, no fees at over 55,000 in-network Allpoint ATMs worldwide and no fees from T-Mobile for using out-of-network ATMs.

T-Mobile launches mobile checking account T-Mobile MONEYMasterCard

Health Insurance: The Washington state House of Representatives has passed legislation that would restrict out-of-network health care providers from balance-billing consumers.

Regulatory Update: A risk retention group is placed into receivership. State legislators move to limit balance-billing and create invisible reinsurance pool. Private flood insurance growing in Pennsylvania

On top of the regular insurance costs, those customers pay a premium to see out-of-network medical professionals.

Medical billing reform in Arizona pushed

It's been a little more than three months since the out-of-network health care bill was signed into law and some stakeholders claim there remains too much vagueness in the language.It's been a little more than three months since the out-of-network health care bill was signed into law and some stakeholders claim there remains too much vagueness in the language.

Out-of-network law raises more questions than answers

For each employer-medical vendor-package, we report NQTLs in four categories--distinguishing inpatient/intermediate from outpatient care, and in-network from out-of-network services.

The Mental Health Parity and Addiction Equity Act Evaluation Study: Impact on Nonquantitative Treatment Limits for Specialty Behavioral Health Care

Because network providers are typically more cost-effective for both the insured student and the plan, in-network care, as opposed to out-of-network care, is the preferred option.

Your health claims report arrived. Now what? 4 ways to better understand and optimize your student health insurance plan