| Example of In-Network vs. Out-of-Network Costs |
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| Example |
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In-Network
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Out-of-Network
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Provider charge
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$50
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$50
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Amount allowed by insurance contract
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$45
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$45
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Amount paid by contract
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$36 (80%)
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$27 (60%)
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Your bill
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$9 (20%)
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$23 (40% + $5)*
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*This $5 is the difference between what the provider charges and what the insurance company contract allows. 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!
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