What is balance billing?

What is balance billing?

• A. When a provider pays the patient for the difference between the provider's charge and the allowed amount.
• B. When the patient pays a copayment.
• C. When the insurer denies a claim.
• D. When a provider bills the patient for the difference between the provider's charge and the allowed amount.

Answer: (D)

Balance billing is when a provider bills you for the difference between the service charge and the amount the insurer allows or pays. The insurer covers the allowed amount, and if that amount is less than what the provider charged, you may be billed for the remaining balance. This is different from a copayment, which is a fixed amount you pay at the time of service, and from an insurer denying a claim, which means no payment is made. In many cases, plans or laws limit balance billing, especially for in-network care or certain emergency services.

Balance billing is when a provider bills you for the difference between the service charge and the amount the insurer allows or pays. The insurer covers the allowed amount, and if that amount is less than what the provider charged, you may be billed for the remaining balance. This is different from a copayment, which is a fixed amount you pay at the time of service, and from an insurer denying a claim, which means no payment is made. In many cases, plans or laws limit balance billing, especially for in-network care or certain emergency services.