Balance billing
Balance Billing
Balance billing (pronounced: /ˈbaləns ˈbiliNG/) is a billing practice where a healthcare provider bills a patient for the difference between the provider's charge and the amount allowed by the patient's health insurance plan.
Etymology
The term "balance billing" is derived from the practice of billing the patient for the remaining balance after insurance has paid its portion.
Definition
In the context of healthcare, balance billing refers to the amount that healthcare providers may charge patients for covered services in addition to what the insurance company pays. This typically occurs when the healthcare provider is not in the patient's insurance network and can result in unexpected costs for the patient.
Related Terms
- Out-of-Network: Refers to healthcare providers or facilities that do not have a contract with a particular health insurance company. Out-of-network providers may balance bill patients.
- In-Network: Refers to healthcare providers or facilities that have a contract with a particular health insurance company. In-network providers typically cannot balance bill patients.
- Health Insurance: A type of insurance coverage that pays for medical and surgical expenses incurred by the insured.
- Surprise Billing: A term often used interchangeably with balance billing, though it specifically refers to instances where patients are unknowingly treated by out-of-network providers.
Legislation
In the United States, the No Surprises Act was signed into law in 2020 to protect patients from surprise medical bills and high out-of-network cost-sharing for both emergency and non-emergency care. The law, which took effect on January 1, 2022, essentially bans balance billing in many healthcare scenarios.
See Also
External links
- Medical encyclopedia article on Balance billing
- Wikipedia's article - Balance billing
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