Which statement describes in-network status for a healthcare provider?

• A. The provider is always out-of-network
• B. The provider has a contract with the payer to accept negotiated rates
• C. The provider charges whatever they want
• D. The provider must be in a hospital

Answer: (B)

In-network status means the provider has a contract with the payer that sets negotiated rates for services. The provider agrees to accept those rates as payment in full for covered services, and the patient pays any required cost-sharing (copays and deductibles) according to their plan. Because of the contract, the payer reimburses the provider at the negotiated rate, reducing out-of-pocket costs for the patient and often limiting balance billing for in-network care. Being in-network does not require the provider to be inside a hospital; physicians, labs, or clinics can be in-network independently of hospital status.