The use of health care providers who have not contracted with the health plan to provide services. Depending on your contract, out of network services may not be covered. Please refer to your contract for specific benefit coverage.
Care or treatment you receive from dentists or other providers who are not participating providers. Out-of-network services are covered, but you may be billed for the balance.
under the PPO, care or treatment you receive from physicians, hospitals, or other health care professionals who are not participating in a physician network.
Health care services from providers not in an HMO´s or a PPO´s network. Except in certain situations, HMOs will only pay for care received from within its network. If you´re in a PPO plan, you will have to pay more to receive services outside the PPO´s network.
For the HMO programs, this term refers to covered services that are not provided or authorized by the PCP. For the PPO programs, this term refers to care not rendered by a PPO network provider.
Services performed by a provider who has not signed a contract with the member’s health plan to be part of a provider network.