What is "balance billing"?

Balance billing refers specifically to the practice of billing a patient for the difference between what their insurance company pays for a particular service and the total amount charged by the healthcare provider. For example, if a healthcare provider charges $200 for a service and the insurance company pays $150, the provider may bill the patient for the remaining $50. This practice typically occurs when a provider is not contracted with the patient's insurance network, allowing them to charge the full amount without being limited to just the insurance payment.

This practice is particularly significant in discussions about patient rights and financial transparency in healthcare, as it can lead to unexpected medical expenses for patients. Understanding balance billing is crucial for healthcare access associates, as they often help patients navigate billing practices and understand their financial responsibilities regarding healthcare services.