What is a key distinction between "non-participating" and "participating" providers?

The key distinction between "non-participating" and "participating" providers lies in the fee structure and billing practices. Non-participating providers are not contracted with an insurance company, which gives them the freedom to set their own fees. As a result, they often charge higher fees compared to participating providers, who have agreed to accept the insurance company's approved payment rates for their services. Participating providers typically have a negotiated fee schedule with the insurance payer, which often leads to lower out-of-pocket costs for patients.

In contrast, participating providers are bound by their agreements with insurance carriers to accept the insurer's fees as payment in full. This can create some confusion, as patients may not always understand why billing practices differ between provider types. Non-participating providers retain the ability to bill patients for the difference between their charges and the insurer's payment, which can result in higher out-of-pocket expenses for patients receiving care from these providers. Thus, the statement regarding non-participating providers potentially charging higher fees is accurate and highlights this critical distinction in the healthcare billing process.