Par (Participating) Providers:
- Contracted with insurance plans to provide services at agreed-upon rates.
- Accept the insurance’s allowed amount as full payment (minus patient copays, deductibles, or coinsurance).
- Patients typically pay lower out-of-pocket costs.
- Must follow the insurer’s rules and guidelines for claims submission and patient care.
Non-Par (Non-Participating) Providers:
- Not contracted with insurance plans and do not agree to their rates.
- Can charge higher fees than the insurance’s allowed amount, leaving patients responsible for the difference (balance billing).
- Patients often have higher out-of-pocket costs.
- May require upfront payment from patients, who can then seek reimbursement from their insurance.
In summary, Par providers have agreements with insurers, offering lower costs for patients, while Non-Par providers operate without such agreements, potentially leading to higher patient expenses.