The Fineprint
What to Do If a Provider Is
Out-of-Network
If you check if a doctor is in-network, and they are out-of-network, it can be stressful.​ While out-of-network care often costs more, you still have options.
This guide walks you through what to do next, who to call, and how to protect yourself financially.
What Does Out-of-Network Mean?
An out-of-network provider does not have a contract with your health insurance plan.
​Because of this, your insurance may:
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Pay less for the service
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Require you to pay coinsurance instead of a copay
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Leave you responsible for balance billing
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Deny coverage entirely (depending on your plan)
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This does not always mean you must pay the full cost – but it does mean you should pause and ask questions before receiving care.
If a Provider Is Out-of-Network
If a provider is out-of-network, first call your insurance company to understand coverage, then call the provider’s office to understand actual costs and payment options.
Step 1: Call Your Insurance Company to Confirm Coverage & Exceptions
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This is to understand what your insurance will and won’t cover before making decisions. Call the number on the back of your insurance card.
Ask specifically:
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To confirm if the provider is out-of-network
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What you would still need to pay
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Exceptions & waivers
Step 2: Decide Whether to Look for an In-Network Alternative
If insurance confirms there are in-network options:
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Ask your insurer for a list of in-network providers
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Consider switching providers if medically appropriate
If no reasonable in-network options exist, move on to the next step.
Step 3: Call the Provider’s Office for Costs & Alternatives
This is to understand real-world costs and billing details before receiving care.
Ask specifically about:
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Alternatives (in-network provider availability)
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Cost estimate
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Billing details
Step 4: Ask Provider About Payment Options or Financial Assistance
Use this only after you’ve received a cost estimate for your care.
Special Situations to Know About
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Emergency care: Emergency services are often covered at in-network rates, even if the provider is out-of-network
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Facility-based care: You may receive bills from providers you didn’t choose (such as labs or anesthesiologists)
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Follow-up care: Post-emergency or follow-up visits may not have the same protections
Always clarify coverage before non-emergency follow-up care.