How are out-of-network emergency services typically treated?

• A. Always paid at in-network rate.
• B. Covered at the same level as in-network.
• C. Not covered at all.
• D. Often covered at in-network or higher levels of reimbursement, but typically at higher cost-sharing for out-of-network emergencies.

Answer: (D)

When you receive emergency care from an out-of-network provider, plans typically protect you from balance billing by paying the out-of-network provider at least as favorably as they would for in-network care. In practice, that means the insurer may reimburse the out-of-network emergency provider at the in-network rate or even at a higher level to ensure the care is covered. However, you generally still face higher cost-sharing (deductible, coinsurance, or copays) for out-of-network emergencies than for in-network ones. So the usual situation is reimbursement at in-network or higher levels, with higher cost-sharing for the patient.