Which statement best describes out-of-network benefits in UnitedHealthcare plans?

• A. They always cover 100% of charges.
• B. They require no prior authorization.
• C. They have lower costs than in-network benefits.
• D. Costs are higher and may include balance billing or limited coverage.

Answer: (D)

Out-of-network benefits apply when you receive care from providers who aren’t contracted with UnitedHealthcare. Because those providers don’t accept the plan’s negotiated rates, the plan typically pays a smaller portion of the bill. You are more likely to face higher out-of-pocket costs, possibly including balance billing—the provider charging you for the difference between their charge and the plan’s allowed amount—and coverage that is limited or unavailable for many services outside the network. In practice, this means you’ll usually pay more when you go out of network, and some services may not be covered unless in an emergency or under specific plan terms. That combination—higher costs and potential balance billing or limited coverage—best captures how out-of-network benefits work in UnitedHealthcare plans.