Out-of-network (Out-of-plan)

This phrase usually refers to physicians, hospitals, or other health care providers who are considered nonparticipants in an insurance plan (usually an HMO or PPO). Depending on an individual’s health insurance plan, expenses incurred by services provided by out-of-plan health professionals may not be covered, or covered only in part by an individual’s insurance company.

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Related Terms

Admitting Privileges
Benefit
Carrier
Certificate of Insurance
Claim
Co-insurance
Co-payment
Deductible
Denial of Claim
Dependents
Effective Date
Exclusions
Explanation of Benefits
Group Insurance
Health Maintenance Organizations (HMO)
HIPPA
In-network
Indemnity Health Plan
Individual Health Insurance
Length of Stay (LOS)
Lifetime Maximum Benefit
Limitations
Long-term Care Policy
Managed Care
Maximum Dollar Limit
Medigap Insurance Policies
Network
Open-Ended HMO
Out-of-pocket Maximum
Outpatient
Pre-admission Certification
Pre-admission Review
Pre-admission Testing
Pre-existing Conditions
Preferred Provider Organizations (PPO)
Primary Care Provider (PCP)
Provider
Reasonable & Customary Fees
Rider
Second Opinion
Second Surgical Opinion
Short-term Disability
Short-term Medical
State Mandated Benefits
Stop-loss
Usual, Customary, & Reasonable (UCR) or Covered Expenses
Waiting Period

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