What is the difference between in-network and out-of-network services?
In-network services are covered services or supplies a member receives from plan physicians or plan providers. Out-of-network services are services or supplies a member receives from non-plan physician or other non-plan provider that is not in the Health Advantage provider network. Emergency care and urgent care services that meet the emergency care guidelines, are covered at the in-network benefit level up to the allowable charge. (See definition for “emergency care” and “urgent care” in your Evidence of Coverage). The member may be billed the difference between billed charges and allowable charges for services received from non-plan providers.
