What does "network out-of-network" refer to in health insurance?

"Network out-of-network" in the context of health insurance refers to services obtained from healthcare providers that are not contracted with the insurance company. This distinction is critical in understanding how health insurance plans categorize healthcare providers and the associated costs to policyholders.

When health insurance plans create a network, they negotiate rates with specific healthcare providers, which are referred to as in-network providers. Patients typically enjoy lower out-of-pocket costs when they utilize these providers. Conversely, when services are obtained from out-of-network providers, the costs tend to be higher because these providers are not part of the insurance company's established agreements. This often results in higher deductibles, co-payments, or even the possibility that certain services may not be covered at all.

The other options do not accurately capture the essence of "network out-of-network." Services received from a primary care physician might fall under either category depending on whether that physician is involved in the insurance plan's network. Similarly, services covered at a lower cost do not specify the network status and apply primarily to in-network situations. Lastly, services available only through the insurance marketplace do not pertain to the network status but rather focus on the method by which insurance plans are accessed. Thus, the definition pertaining specifically to healthcare provider contracts