Medical balance billing, also known as surprise billing, occurs when a patient receives a bill for the difference between what their health insurance company pays for a medical service and what the healthcare provider charges for that service.
Balance billing usually occurs when a patient receives care from an out-of-network healthcare provider, or when an in-network healthcare provider refers the patient to an out-of-network provider, without informing the patient of the out-of-network status.
For example, let’s say a patient goes to an in-network hospital for an emergency procedure. However, the anesthesiologist or radiologist who performed the procedure is not in the patient’s insurance network. The patient’s insurance company may pay the in-network amount for the procedure, leaving the patient responsible for paying the difference between the in-network rate and the out-of-network provider’s charge.
Medical balance billing can result in significant financial burdens for patients, and many states have enacted laws to protect patients from this practice. Some of these laws require healthcare providers to disclose their network status to patients, or require insurers to pay for out-of-network care at a certain rate.
Overall, medical balance billing can occur when patients receive care from out-of-network providers and can result in unexpected medical bills. It’s important for patients to understand their insurance coverage and seek care from in-network providers whenever possible to avoid this type of billing.
Do you have a balance bill or legal concern? BenefitsDNA has resources that can help, reach out to our team today!
