In the United States, some health insurance plans are designed so that the submitted expenses accumulate towards both the in-network and out-of-network deductibles (sometimes referred to as combined or integrated). Example of such clause:

Maximums for specific covered expenses, including visit, day and dollar maximums are combined maximums between network and out-of-network, unless specifically stated otherwise.

In such plans, is it financially preferable to visit out-of-network medical providers before reaching the in-network deductible, if one has to visit an out-of-network medical provider and that it is possible time the visit as one wishes, or did I miss something? (assuming that the out-of-network deductible is higher than the in-network deductible)

1 Answer 1


You want to avoid out-of-network unless the quality of care, or convenience of the visit makes the extra expense worth it. In almost all cases out-of-network visit will cost more money than a covered in-network visit. This is compounded by the fact that the insurance company will only credit you as having spend what would have been the in-network negotiated rate.

For example for a recent procedure for a family member.

 - Billed rate       $631.00
 - Negotiated rate   $148.00

Unless you can get the rate you pay out-of-network under $148 the insurance company will only credit your deductibles for the $148.00

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