Which term best describes a provider that does not have a participation agreement with a plan?

• A. In-network
• B. Out-of-network
• C. Non-participating
• D. Preferred

Answer: (B)

Out-of-network describes a provider who does not have a contract or participation agreement with the health plan. Without that contract, the plan hasn’t set negotiated rates for the provider, and coverage is often limited, which can mean higher costs for the patient and possible balance billing. In-network providers have a participation agreement with the plan and adhere to negotiated rates, making care more affordable under the plan. The term could be confused with non-participating in some contexts, but the standard way to describe no contract with the plan is out-of-network. A “preferred” designation does not imply the absence of a contract; it usually signals a subset of in-network providers that the plan highlights.