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

Many plans with out-of-network (OON) benefits have a separate out-of-network deductible expressed as a dollar amount you must pay out of pocket before your insurer starts reimbursing you for OON services. This deductible is often higher than your in-network deductible and resets each plan year (usually January 1, or your plan’s anniversary date). You usually have to meet each deductible separately. Hitting one doesn’t count toward the other.

Once you’ve met your OON deductible, your insurer will begin reimbursing you at the coinsurance rate specified in your plan (e.g., 70% of the allowed amount). Claims you file before meeting your deductible still count toward satisfying it, even if you receive no reimbursement check for those claims.