Out-of-Network Co-Insurance

What is out-of-network co-insurance?

Out-of-network co-insurance is the percentage of a patient’s cost of care that they have to pay when they seek healthcare services from providers who are not covered by their insurance plan.

For patients who have deductibles associated with their insurance plans, the co-insurance costs do not kick in until the deductible is met. Deductibles are the amount of healthcare costs a patient needs to pay before their insurer starts to pay for their care.

For example, a patient who has met their deductibles and is being billed $50 for a doctor’s visit will pay $5 for that visit on a healthcare plan that requires 10% co-insurance for that service.

Why is out-of-network co-insurance important to healthcare?

Out-of-network co-insurance costs are important for healthcare consumers to consider because they may be very high for certain tests and services. This may apply especially when the patient has a long-term serious condition that requires expensive drugs and tests.

On average, plans that provide low co-insurance fees may provide higher premiums, while those that provide higher co-insurance fees provide lower premiums.

In addition, out-of-network co-insurance costs are typically higher than in-network co-insurance costs, as out-of-network care lacks the pre-negotiated fee for specified services with the provider.