Balance Billing

Balance billing is one of those health insurance terms that has been getting a lot of press recently. Basically, balance billing is when your provider bills you for the difference between what they charged for their services and what your insurance company agreed to pay. For example, if your doctor charged you $100 for an office visit, but your insurance company will only pay $70, the doctor may bill you the remaining $30. As a rule, providers in your network won’t balance bill. However, out-of-network providers are well within their rights to bill you for what your insurance doesn’t pay. The current brouhaha is from when people go to an in-network facility but are treated by an out-of-network provider, which they don’t usually know until the bill comes. These are considered “surprise” bills and are creating quite a bit of angst for insurance companies and regulators.

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