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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.

Table of Contents:

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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:

  • Pay less for the service

  • Require you to pay coinsurance instead of a copay

  • Leave you responsible for balance billing

  • Deny coverage entirely (depending on your plan)

​

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.

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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:

  • To confirm if the provider is out-of-network

  • What you would still need to pay

  • Exceptions & waivers

Step 2: Decide Whether to Look for an In-Network Alternative

If insurance confirms there are in-network options:

  • Ask your insurer for a list of in-network providers

  • 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:

  •  Alternatives (in-network provider availability)

  • Cost estimate

  • 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

  • Emergency care: Emergency services are often covered at in-network rates, even if the provider is out-of-network

  • Facility-based care: You may receive bills from providers you didn’t choose (such as labs or anesthesiologists)

  • Follow-up care: Post-emergency or follow-up visits may not have the same protections

 

Always clarify coverage before non-emergency follow-up care.

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