What does "network provider" refer to in health insurance?

The term "network provider" refers specifically to a healthcare provider who has entered into a contract with a health insurance plan to deliver services to its members at negotiated rates. This contractual agreement typically means that the provider agrees to adhere to certain terms and conditions regarding the pricing of services, ensuring that insured individuals can receive care at lower out-of-pocket costs compared to non-network providers.

Choosing a network provider is advantageous for members because they gain access to a wide range of services without facing excessive copayments or deductibles, which are often higher when using out-of-network providers. Moreover, health insurance plans prefer their members to use network providers since it helps manage costs and ensures continuity of care within a preferred provider system.

The other options do not accurately reflect the definition of a network provider. A local healthcare provider does not imply any association with an insurance plan’s network. A provider offering emergency services only is not necessarily part of a network unless they have a contract with a specific insurer. A secondary provider for out-of-network referrals does not align with the concept of network providers, as that scenario typically involves additional costs and complexities outside of network agreements.