What does "balance billing" mean?

What does "balance billing" mean?

• A. The practice of billing a patient for the full amount of services rendered
• B. Charging a patient the difference between what an insurer pays and what the provider charges
• C. A method of estimating costs before a treatment
• D. Billing a patient before services are rendered

Answer: (B)

Balance billing refers specifically to the practice where a healthcare provider charges a patient for the difference between the amount billed for services and the amount that the insurance company has covered. This situation can arise when a patient receives care from an out-of-network provider, who has charged more than what the insurance is willing to pay. In this context, when a patient has insurance that covers a portion of the medical service cost, the provider can bill the patient for the remaining balance that the insurance does not cover. This practice can often lead to patients being surprised by large bills that they did not expect after their insurance has processed the claim. Understanding balance billing is crucial for patients in managing their healthcare expenses and knowing what to expect regarding potential costs associated with their medical services. It also highlights the importance of confirming which healthcare providers are in-network to avoid unexpected charges.

Balance billing refers specifically to the practice where a healthcare provider charges a patient for the difference between the amount billed for services and the amount that the insurance company has covered. This situation can arise when a patient receives care from an out-of-network provider, who has charged more than what the insurance is willing to pay.

In this context, when a patient has insurance that covers a portion of the medical service cost, the provider can bill the patient for the remaining balance that the insurance does not cover. This practice can often lead to patients being surprised by large bills that they did not expect after their insurance has processed the claim.

Understanding balance billing is crucial for patients in managing their healthcare expenses and knowing what to expect regarding potential costs associated with their medical services. It also highlights the importance of confirming which healthcare providers are in-network to avoid unexpected charges.