Balance Billing

Balance Billing


Balance billing, sometimes called extra billing, occurs when a healthcare provider bills a patient more than the amount their health insurance reimburses.

For example, if the provider’s charge is $250 for a service and the amount allowed by the patient’s insurance is $200, the provider may bill the patient $50 ($250 – $200 = $50). However, a preferred provider may not balance bill.

Any amount that is balance billed is an added cost to the consumer above and beyond the expected deductible and out-of-pocket expense.

Balance Billing is controversial

Advocates of balance billing argue:

  • Balance billing increases the incomes of high-quality healthcare providers.
  • It serves as a measure of healthcare providers’ dissatisfaction with insurance company fees.

Critics argue:

  • Balance billing lets providers raise charges through stealth rather than transparency.
  • Creates unnecessary administrative costs and patient confusion.
  • Allows insurers to simply pass along costs to patients, rather than helping them to secure good value.
  • It keeps some people from getting the care they need by making it too expensive.

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