Lamont has a point-of-service plan and seeks health services outside the network. What will likely be the end result?

• A. Higher out of pocket costs
• B. No impact on costs
• C. POS covers all out-of-network services at identical rates
• D. Lower out-of-pocket costs

Answer: (A)

In a point-of-service plan, costs are lowest when you stay in-network, and the plan typically covers out-of-network care at a reduced rate with higher cost-sharing for you. When Lamont seeks services outside the network, the plan usually reimburses less of the bill and you may owe the difference between the provider’s charge and what the plan considers allowed, along with higher deductibles or coinsurance. So the likely result is higher out-of-pocket costs. The other options don’t fit because out-of-network care in a POS plan isn’t covered at the same favorable rates, and costs aren’t unchanged or reduced by going off-network.