What term describes a provider who does not contract with an insurance plan?

The term that describes a provider who does not contract with an insurance plan is "Nonparticipating Provider," often abbreviated as nonPAR. These providers have chosen not to enter into agreements with specific insurance companies regarding payment structures, fee schedules, or network participation. As a result, they are not bound by the insurance plan's terms and may bill patients directly, which can sometimes lead to higher out-of-pocket costs for patients compared to services rendered by providers who are part of the insurance network.

Nonparticipating providers typically can decide what fees to charge for their services, and patients may have to pay the provider's full charges upfront and then seek reimbursement from their insurance company, rather than having the insurance pay a contracted rate directly to the provider. Understanding the distinction between nonparticipating and participating providers is crucial for navigating health care services and managing costs effectively in the revenue cycle management process.