Why is there a difference in cost between in-network and out-of-network providers?

When you use in-network providers, fees for eligible services have been negotiated in advance by your Medical Plan administrator, generally resulting in lower costs. Out-of-network providers have not agreed to negotiated rates and can charge any amount they choose. Additionally, your Medical Plan administrator will impose a Reasonable & Customary (R&C) limit for services, which is the average rate for services in a geographic location. If your out-of-network provider charges more than R&C, you will be responsible for the amount over the R&C limit, in addition to a greater percentage of coinsurance.

This entry was posted in . Bookmark the permalink.