Out-of-network (OON)
A provider who doesn't have a contract with your plan. Cost-sharing is higher and you may face balance billing — unless NSA protections apply.
Out-of-network providers have no contract with your plan. Costs are higher and historically patients faced balance billing for the difference between billed and allowed amounts. The No Surprises Act (2022) prohibits balance billing in emergency, post-stabilization, air ambulance, and OON-at-in-network-facility scenarios. Outside those protections, OON costs still apply unless the plan has out-of-network benefits.
Frequently asked questions
What is out-of-network (oon)?
Out-of-network providers have no contract with your plan. Costs are higher and historically patients faced balance billing for the difference between billed and allowed amounts. The No Surprises Act (2022) prohibits balance billing in emergency, post-stabilization, air ambulance, and OON-at-in-network-facility scenarios. Outside those protections, OON costs still apply unless the plan has out-of-network benefits.
Related terms
- In-networkA provider, facility, or pharmacy that has a contract with your plan to provide services at negotiat
- Balance billingWhen an out-of-network provider bills you the difference between their charge and what your plan pai
- No Surprises Act (NSA)Federal law (effective 2022) banning balance billing for most emergency and certain non-emergency ou
- Federal IDR (No Surprises Act dispute resolution)The 'baseball arbitration' process between out-of-network providers and plans for NSA-covered servic
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