What is an Out-of-Network Provider?

An out-of-network provider is a healthcare professional, hospital, or facility that hasn't contracted with your insurance company to provide services at negotiated rates. Using out-of-network providers typically results in higher costs, including higher deductibles and coinsurance, and may involve balance billing where you're responsible for the difference between the provider's charge and your insurance's allowed amount.

Why out-of-network providers matter

• Increases costs significantly: Often results in paying much more for the same services
• May lack coverage: Some plans provide no coverage for out-of-network care except in emergencies
• Creates billing complexity: Requires more paperwork and may involve balance billing

How Solace can help

A Solace advocate can help you understand out-of-network costs, negotiate with providers for reduced rates, and explore in-network alternatives. Advocates can also assist with balance billing disputes and help determine when out-of-network care might be covered due to network inadequacy.