What is the difference between in-network and out-of-network services on a point-of-service (POS) plan?
In-network services are covered services or supplies a member receives from plan providers as a result of an authorization from the member’s PCP or Health Advantage. Out-of-network services are services or supplies a member receives from providers other than plan providers or services that are not received as a result of an authorization from the member’s PCP or Health Advantage. Emergency-care and urgent-care services are considered in-network services and are covered up to the allowable charge. The member may be billed the difference between billed charges and allowable charges for services received from nonplan providers.
