Which term describes a provider without a participation agreement with a plan?

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

Answer: (D)

Understanding how health insurance networks work helps here. If a doctor or facility hasn’t signed a contract to participate with a plan, they aren’t part of that plan’s network. Providers outside the network are described as out-of-network, reflecting that the insurer and the provider don’t have a negotiated, plan-specific agreement. Because there’s no contract, the plan may reimburse at a different (often lower) rate and you could owe more, including potential balance billing in some cases.

A few other terms won’t fit as well: in-network providers have contracts with the plan, so they’re within the network; a preferred provider implies network status within a specific plan’s structure but still denotes contracted status; a non-contracted provider describes the same idea but isn’t the standard label used for the outside-network category. Thus, the best term is out-of-network provider.