Non-par providers

A non-par provider is a healthcare professional or facility that does not have a contract with your health insurance network. Non-par providers, such as out-of-network surgeons and labs, can charge rates above what insurers consider usual and customary.

Insurance plans like PPOs often reimburse non-par providers at lower percentages–typically 50% of allowed charges–compared to in-network rates. Patients who use non-par providers may face balance billing, where they pay the difference between insurer reimbursement and provider charges.

Emergency care from non-par hospitals must be covered by insurers under federal law, but patients still risk higher out-of-pocket costs for follow-up visits. Non-par status affects claims processing speed; insurers process these claims manually, which can delay payment by several weeks compared to automatic adjudication for par providers.

Insurers maintain directories listing par versus non-par cardiologists, dermatologists, and other specialists so members can verify network participation before appointments, as per the Insurance Information Database. Some employer-sponsored health plans exclude coverage entirely for services from non-par physical therapists or imaging centers except in emergencies.

Out-of-network deductibles and coinsurance amounts are usually higher than those applied to par provider services according to plan documents filed with state regulators.