Which term describes a provider that does not participate with the plan?

Which term describes a provider that does not participate with the plan?

• A. In-network
• B. Out-of-network
• C. Non-participating
• D. Preferred

Answer: (B)

A provider that does not participate with the plan is out-of-network. Health plans create a contracted network of in-network providers. When a provider isn’t part of that network, there’s no negotiated rate with the plan, so reimbursement is typically lower and you may face higher out-of-pocket costs or balance billing. In-network describes those who have a contract with the plan and are paid at higher, pre-set rates. Preferred refers to a status within a network and doesn’t specifically indicate nonparticipation.

A provider that does not participate with the plan is out-of-network. Health plans create a contracted network of in-network providers. When a provider isn’t part of that network, there’s no negotiated rate with the plan, so reimbursement is typically lower and you may face higher out-of-pocket costs or balance billing. In-network describes those who have a contract with the plan and are paid at higher, pre-set rates. Preferred refers to a status within a network and doesn’t specifically indicate nonparticipation.