| Example Of In-Network Vs. Out-Of-Network Costs |
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| Example |
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| 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.
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