When you see a doctor or other health care provider, you may owe certain out-of-pocket costs, such as a copayment, coinsurance, and/or a deductible. You may have other costs or have to pay the entire bill if you see a provider or visit a health care facility that isn’t in your health plan’s network. “Out-of-network” describes providers and facilities that haven’t signed a contract with your health plan. Out-of-network providers may be permitted to bill you for the difference between what your plan agreed to pay and the full amount charged for a service. This is called “balance billing.” This amount is likely more than in-network costs for the same service and might not count toward your annual out-of-pocket limit. “Surprise billing” is an unexpected balance bill. This can happen when you can’t control who provides your care. Emergency care or being treated by an out-of-network provider at an in-network clinic are examples of when they may occur.

No. Out-of-pocket costs of copays, deductibles, and coinsurance are part of the benefit design with your health coverage and you are expected to pay these amounts up to the out-of-pocket maximum limit defined by your coverage. Note that in-network benefits can differ significantly from out-of-network benefits. You may have higher out-of-pocket costs if your coverage is considered out-of-network at Stanford Health Care or its affiliates.

No. But you will likely pay higher out-of-pocket costs when seeing an out-of-network provider.