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Out of Network Fee

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Definition: An out of network fee is given when a doctor, hospital, or medical specialist is used that is not in your insurance network of approved providers. This type of fee is often seen if you are part of a managed health care plan, such as a HMO or PPO type of insurance because managed health plans use only providers that agree to participate in their specific insurance plan. Out of network fees vary depending on your insurance plan, so it is important to review your plan and understand what your insurance company charges for using an out of network medical specialist.

If you find an out of network fee on your hospital or insurance bill, make sure you know why you are being charged it. Sometimes there are mistakes in billing and items overlooked. For example, if you chose an in-network hospital but the hospital used an out of network specialist without your consent, then you may not be responsible for the out of network fees.

Examples:
Mary needed hand surgery. Her friend recommended Dr. Cutter. Unfortunately, Dr. Cutter was not an approved provider on her insurance plan, so if she decided to go to Dr. Cutter she would be billed an out of network fee.
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