Definitions for "Out-of-network care"
Out-of-network care is care received outside of the approved network as described by the health plan option covering you. Generally, when receiving care out of the network, additional costs must be paid by the member receiving services (e.g. deductibles and co-insurance). If you have selected the HMO option, you will need a referral to see a health care provider other than your PCP for services in or out of the network.
Care you receive from a provider who is not part of the network (out-of-network provider). Typically, you pay more when you receive out-of-network care.
Medical services obtained by managed care plan members from unaffiliated or noncontracted health care providers. In many plans, such care will not be reimbursed unless previous authorization for such care is obtained.