Florida Health Insurance Definitions

Florida Health Insurance Terms:

Define: "Out-of-Network"

Out of network is the use of health care providers who have not contracted with the health plan to provide services. HMO members are generally not covered for out-of-network services except in emergency situations. Members enrolled in Preferred Provider Organizations (PPO) and Point-Of-Service (POS) coverage can go out-of-network, but will pay some additional costs.

More Examples of Out-of-Network:

If you choose to receive out-of-network care, please consider the following:

You must contact us for approval* before you receive certain services. (This includes hospital admissions and certain surgical and diagnostic procedures.) If you don’t, you will not be eligible for full benefits and our payment may be reduced.

Most out-of-network services are subject to a deductible and coinsurance, so you will have a greater out-of-pocket expense for the care received.

Example -- You choose to go out of network for an office consultation: the charge is $950. Since the service is performed out of network, an office visit copayment does not apply. The deductible has already been met. Our payment allowance for this service is $500, less any applicable coinsurance and/or deductible amounts. Further details - Out-of-Network:: Search Horizon Network


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