What is typically a consequence of being treated by an out-of-network provider?

Being treated by an out-of-network provider generally results in higher costs for the insured. This is due to the fact that insurance plans typically have negotiated rates with in-network providers, which means the out-of-pocket expenditures for these services are lower when using in-network options. When a patient opts to seek care from an out-of-network provider, they are usually subject to higher co-pays, deductibles, and overall reimbursement rates.

Additionally, out-of-network providers may not have the same agreements with the insurance company to cover services at the same rate as in-network providers, leading to increased financial responsibility for the patient. This can also include balance billing, where the provider charges the patient for the difference between what the insurance pays and what the provider bills, further increasing the patient's costs.

While there are benefits to seeing out-of-network providers, such as avoiding the need for referrals (which is applicable in some managed care plans), the financial implications of higher costs are the primary consequence of this choice.