Out-of-Network (OON)

Services received from a provider who does not have a contract with the member's health plan. OON benefits are often reduced or excluded. However, when a plan's in-network behavioral health provider network is inadequate, members have the right to use OON providers at in-network cost-sharing rates — this is called the 'single case agreement' or 'network gap exception.' Network adequacy failures can be appealed as MHPAEA NQTL violations.