What’s the difference between out-of-network and in-network medical providers?

In-network providers have a contract with your insurance company. When you see one, your insurer covers the cost according to your plan’s negotiated rates.  You typically just pay a copay or coinsurance.

Out-of-network (OON) providers do not have a contract with your insurer. When you see an OON provider, you generally pay the full cost upfront, then submit a claim to your insurance company for partial reimbursement. How much you get back depends on whether your plan has OON benefits and how far you’ve progressed toward your OON deductible.