Out-of-Network

This refers to a patient seeking care outside the network of doctors, hospitals or other health care providers that the insurance company has contracted with to provide care.  It usually applies to health maintenance organizations (HMOs) and preferred provider organizations (PPOs).  If a patient does seek out-of-network care, those services may only be partially covered or not covered at all, depending on the insurance plan. HMO health plans typically do not provide any out-of-network medical or mental health coverage or may due to with prior authorization from your primary care provider.