A non-participating provider is a healthcare professional or facility that has not entered into a contract with a specific insurance plan or Medicare to accept their reimbursement rates for medical services. While non-participating providers may still treat patients covered by the insurance plan, they are not obligated to accept the plan’s payment rates and may charge patients higher fees or balance-bill them for the difference between the provider’s charge and the plan’s reimbursement. Patients who seek care from non-participating providers may face higher out-of-pocket costs compared to using in-network providers or participating providers who have agreed to accept the plan’s payment terms.
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