What happens if a non-member physician is utilized under a POS plan?

In a Point of Service (POS) plan, when a member chooses to see a non-member physician, they typically face higher out-of-pocket costs compared to choosing an in-network provider. This is due to the way many health insurance plans are structured; they incentivize members to use network providers with lower costs and greater benefits.

When a member goes outside of the network, they are often subject to higher coinsurance rates. Coinsurance is the percentage of costs of a covered healthcare service that the insured pays after they've paid their deductible. Since non-member physicians are not part of the insurance plan's negotiated network agreements, the costs associated with their services would be higher for the member, resulting in increased coinsurance amounts. This aligns with how POS plans generally operate, ensuring that members are encouraged to use in-network services.

The other options imply scenarios that do not align with typical POS structures. If the attending physician were paid at the in-network rate, it would negate the purpose of having non-member professionals, as it would undermine the cost incentive for choosing in-network care. Paying just a co-pay would typically be reserved for in-network visits, and claims aren't outright denied; instead, they are processed with higher cost-sharing for the members using non-network providers. Thus