Under a point of service (POS) plan, how does the cost-sharing mechanism work with non-member physicians?

In a point of service (POS) health insurance plan, members have the flexibility to choose between in-network and out-of-network providers at the time they seek care. When members opt to see non-member or out-of-network physicians, the cost-sharing mechanism typically requires them to pay a higher co-pay. This reflects the increased financial responsibility members take on when choosing to go outside of their plan's network.

POS plans are designed to encourage members to use in-network providers, as these physicians have contracted rates with the insurer that result in lower costs for the plan and, consequently, lower costs for members. When a member sees a non-member physician, the insurer may cover a portion of the cost, but the higher co-pay is a financial disincentive for using out-of-network services. This structure helps manage costs for both the insurer and the members, while still allowing for flexibility to receive services from a broader range of providers.

In contrast, options suggesting that insurance covers the full expense or that members pay reduced fees do not align with how POS plans are structured, as those scenarios would not provide the necessary cost control. Similarly, the idea that the attending physician is not compensated is not accurate, as out-of-network physicians can still receive payment for services,