Skip to main content
Language Foundation

out of network

For a particular health insurance plan, out of network is the status of a health care provider that is not part of the plan’s contracted provider network.

In plain English

A health plan has a group of providers it has contracts with. When a provider is outside that contracted group for a specific plan, this status applies.

In context

In a directory or claim message, out of network communicates that the provider is not in the contracted network for the health insurance plan being referenced.

Situation
Checking provider networks, authorization, referrals, eligibility, and preapproval states
What it communicates
labels a provider's network relationship in a directory or claim message.

Meaning limits

By itself, this status does not establish any decision about payment or approval.

Examples

“The specialist was out of network for her health plan, but her regular doctor was in network.”

Core meaning

“The claim message lists the laboratory as out of network for that plan.”

In context

  • in network Opposite

    It describes a provider that is part of the plan’s contracted provider network.

  • network status Broader Term

    This is one possible status of a health care provider in relation to a plan’s contracted provider network.