insurance
Out-of-Network Provider
ネットワーク外プロバイダー (nettowāku gai purobaidā)
An out-of-network provider does not have a contract with your insurance plan. Using one typically results in higher costs: higher deductibles, higher coinsurance, and sometimes full billing at list prices. Some plan types (HMO, EPO) do not cover out-of-network care at all except in emergencies. Balance billing — being billed the difference between the provider's charge and the insurer's payment — is a risk when going out of network, though the No Surprises Act restricts this in emergency settings.
Patients who need a specific specialist not in their network should request an exception or single-case agreement from their insurer.
In 9 languages
| Language | Term |
|---|---|
| English | Out-of-Network Provider |
| Japanese (日本語) | ネットワーク外プロバイダー |
| Chinese (中文) | 网络外医疗提供者 |
| Korean (한국어) | 네트워크 외 의료 제공자 |
| Portuguese | Prestador Fora da Rede |
| Spanish | Proveedor Fuera de Red |
| Filipino | Doktor sa Labas ng Network |
| Thai | ผู้ให้บริการนอกเครือข่าย |
| Vietnamese | Nhà cung cấp ngoài mạng lưới |
| Romanization | nettowāku gai purobaidā |
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Browse US healthcare guides →Last reviewed: September 2026