Understanding Balance Billing in Medical Billing Practices

Balance billing is an increasingly common practice in the healthcare industry, and understanding how and when it is used is important for both patients and providers. Balance billing is an arrangement made between a patient and healthcare provider to fill any gaps between what an insurer covers and the total cost of care. Instead of the insurer simply refusing to cover certain treatments or services, balance billing seeks to bridge the gap.

Balance billing typically occurs when a provider charges a higher amount for services than what the insurance plan allows. The additional cost is then billed to the patient. In most cases, the provider and the insurance company have agreed to a set rate and the provider cannot charge a higher amount for the services provided. If the provider does charge a higher rate than the agreed-upon amount, it is considered balance billing.

Balance billing can also apply to non-insured services such as cosmetic or elective procedures not covered by a health insurance plan. In these cases, the provider has determined what they will charge for the service and the patient is responsible for the full cost. This is generally done prior to the delivery of care and there is usually an option to find a provider that will accept the same insurance plan.

When it comes to balance billing practices, the important thing to remember is that both the provider and the insurance company must agree to any reimbursement rate prior to services being rendered. This helps ensure that patients are not stuck with a large bill after a visit and that providers are fairly compensated for their services.