In-network providers have a contract with your plan and accept its negotiated rates; out-of-network providers don’t, so they cost more and can “balance bill” you for the difference between their charge and what your plan allows. In-network providers generally cannot balance bill.
Provider Networks
A Provider Network is a group of healthcare providers that insurance plans contract with to offer medical services to their members. For small group health insurance, understanding the composition and coverage of provider networks is key in guiding businesses and employees to make informed choices about their healthcare options.
What is the No Surprises Act and what does it protect me from?
The No Surprises Act (effective for plan years on or after January 1, 2022) protects you from many surprise out-of-network bills (emergency care, and out-of-network clinicians who treat you at an in-network facility) by limiting your cost to in-network amounts and routing the payment dispute to arbitration. It does not eliminate every out-of-network charge.