An out-of-network provider is one which has not contracted with your insurance company for reimbursement at a negotiated rate. Some health plans, like HMOs, do not reimburse out-of-network providers at all, which means that as the patient, you would be responsible for the full amount charged by your doctor. Other health plans offer coverage for out-of-network providers, but your patient responsibility would be higher than it would be if you were seeing an in-network provider.
Although it may initially cost you more money, there may be times when you might find it necessary, or even advisable, to use an out-of-network provider. Find out more about when in the FAQ When Should I Obtain Out-of-Network Health Care?