Refers to healthcare providers, facilities, or services that have agreed to provide medical care at negotiated rates with a particular health insurance plan. Patients typically pay less out-of-pocket for services received from in-network providers compared to out-of-network providers.
A contract between an individual and an insurance company that provides coverage for medical expenses, including doctor visits, hospital stays, surgeries, prescription drugs, and other healthcare services.
A healthcare professional or facility, such as doctors, hospitals, clinics, pharmacies, and laboratories, that deliver medical services or supplies to patients.
Healthcare providers or services that do not have a contract with a particular health insurance plan. Patients may still receive care from out-of-network providers, but they often face higher out-of-pocket costs or may not have coverage at all, depending on their insurance plan.
A fixed amount that an insured individual pays for covered healthcare services at the time of receiving care. Co-pays for in-network services are typically lower than those for out-of-network services.
The amount of money an insured individual must pay out-of-pocket for covered healthcare services before their insurance plan begins to pay for covered expenses. Deductibles usually apply to both in-network and out-of-network services.
The percentage of costs for covered healthcare services that an insured individual is responsible for paying after meeting their deductible. In-network coinsurance rates are often lower than out-of-network rates.
A group of healthcare providers, facilities, and suppliers that have contracted with a health insurance plan to provide services to its members. Networks can vary in size and composition, and some plans offer larger networks with more providers than others.
A type of health insurance plan that offers a network of preferred providers, but also provides coverage for out-of-network care, usually at a higher cost to the insured individual. PPO plans often do not require referrals to see specialists.
A type of health insurance plan that typically requires patients to choose a primary care physician (PCP) and obtain referrals from the PCP to see specialists. HMO plans usually offer lower out-of-pocket costs for in-network services but may not cover out-of-network care except in emergencies.