Out of Network Care Law and Legal Definition

Out of network care refers to the health care provided to a patient outside the network of a health insurance company's preferred providers. Out of network care services are generally not covered by health insurance plans. Out-of-network health care is generally more expensive.

Many plans make exceptions for out-of-network coverage during an emergency. The circumstances during which a health plan covers out of network care are:

1. where in the middle of treatment for serious or end-of-life issues, if the provider leaves the network;

2. where no primary-care provider is available within a short drive in a rural area; and

3. where medical care is required while a beneficiary is away from home;

4. where there occurs a rare ailment for which no specialist is included in the plan;

5. floods, widespread fires, hurricanes, tornadoes