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Example Of In-Network Vs. Out-Of-Network Costs
Example
 
 
In-Network
Out-of-Network
Provider charge
$50
$50
Amount allowed by insurance contract
$45
$45
Amount paid by contract
$36 (80%)
$27 (60%)
Your bill
$9 (20%)
$23 (40% + $5)*
 
*This $5 is the difference between the provider charge and the amount allowed by insurance contract. You may have to pay this entire difference with an out-of-network provider.
 
This is only an example: It assumes you already met any deductible for the year. The actual percent of medical bill you might pay for in-network or out-of-network providers varies by insurance policy. Your might really pay 30 percent of in-network charges and 50 percent of out-of-network charges, for example. 
 
Bottom line: You could pay a lot more if you don't use in-network providers (sometimes called preferred providers). Make sure you understand your contract!
 
Most insurers must provide out-of-pocket cost estimates (through an interactive website and toll-free number) for the five most common procedures in each of the following categories:
  • Office visits
  • Radiology
  • Laboratory
  • Uncomplicated birth
  • Orthopedics
  • Digestive system endoscopy (a procedure that looks inside the body)
The law requiring this tool does not apply to self-insured employers or insurance companies that issue policies in another state to an employer with Oregon employees.
 
To utilize the cost estimator tool, contact your insurer.