Definitions
Health Insurance Terms
Participating Provider

Participating Provider

Definition:

A physician or other medical provider has agreed to accept a set fee for services provided to members of a specific health plan. They are considered to be "in-network".

Application:

The importance of visiting a participating or non-participating provider is based on the payment rate. Health plans will provide incentives for their members to see a physician who is "participating" with their health plan. This is done because these participating providers have agreed to a reduced fee to provide services. Unlike non-participating providers who have not agreed to a specific rate, and could potentially be paid higher.

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