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What are out-of-network services and do consumers have any coverage for them?


Services are considered out-of-network if they're from a doctor, hospital, or other provider that doesn't have a contractual relationship with a particular health plan. Not all plans cover out-of-network services, but when they do, a consumer's share of the cost is usually higher than for an in-network service. Consumers may want to find out whether a provider is in-network before they receive services. Consumers may also want to find out if their regular health care providers are in-network before they buy a plan.

Though the ACA limits how much money a person is required to spend on his or her family's health care, out-of-network services do not count toward these limits.

A plan's Statement of Benefits and Coverage will include information about coverage for out-of-network services.

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