What is "balance billing"?

Balance billing refers to the practice where a healthcare provider bills a patient for the difference between the total cost of care and the amount paid by the insurance company. This occurs after the insurance has settled its portion of the claim according to the patient's policy terms. For example, if a patient receives a treatment that costs $1,000 and the insurance covers $700, the provider may issue a bill to the patient for the remaining $300.

This practice can be contentious, particularly in scenarios involving out-of-network providers, as it might lead to unexpected financial burdens for patients. It's essential in understanding healthcare billing as it highlights how patient responsibility can vary significantly after insurance reimbursement. Understanding balance billing is crucial for both patients and providers to navigate the financial aspects of healthcare successfully.