In-network vs. out-of-network

A medical network refers to hospitals, doctors, pharmacies, and specialists that are paid a contracted amount for their services.


Rates of hospitals, doctors, pharmacies, and specialists who are in-network are predetermined and negotiated.  As a result, you end up paying less when you receive in-network treatment.


Out-of-network treatment does not have an agreed upon rate for the services offered, so you may end up paying considerably more for those visits. Some plans provide partial coverage for services received out-of-network while others provide none. Refer to your Summary of Benefits and Coverage (SBC) for specific details of your plan, which you can locate on the Benefits tab of your employee account if your benefits are managed by Gusto.