Which term describes a non-participating provider?

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

Answer: (C)

Non-participating describes a provider who has not signed a contract with the insurance plan, so they aren’t part of the network. When a provider isn’t participating, the plan doesn’t offer the negotiated network rates with them, which often means higher costs for the patient and potentially different coverage rules. In-network providers are those who have contracts with the plan and accept negotiated rates; out-of-network describes providers not in the plan’s network, usually with even higher costs or limited coverage; non-contracted is similar in the sense of lacking a contract, but the standard term used is non-participating to describe the provider who does not participate in the network.