Final answer:
When a beneficiary gets care from a non-network, non-participating provider, they may have to pay out-of-network costs, including the deductible and co-insurance.
Step-by-step explanation:
When a beneficiary gets care from a non-network, non-participating provider, they may have to pay out-of-network costs. These costs can include the deductible, co-insurance, and any additional fees that are not covered by the insurance plan. For example, if a beneficiary has a deductible of $1,000 and receives care from a non-network provider, they will have to pay the full cost of the visit until they reach their deductible. After that, they may still have to pay a percentage of the cost as co-insurance.
Overall, the exact amount that a beneficiary may have to pay will depend on their specific insurance plan and the terms set by the insurance company. It is important for beneficiaries to review their insurance policy and understand the coverage and costs associated with receiving care from non-network providers.