Balance billing

What does Balance billing mean on a medical bill?

Balance billing is when a provider bills you for the part of their charge your insurance did not pay. Providers in your plan's network agree to accept the plan's discounted rate as full payment, so this mostly shows up after out-of-network care. Federal and state rules limit it in several situations, especially emergencies and out-of-network doctors working inside an in-network hospital. If a bill looks like the leftover of a charge rather than a normal share, ask the provider in writing which rule they billed under.

What does Balance billing usually cost?

The amount is the gap between the provider's charge and what the plan allowed and paid, so it can dwarf what the same care costs in network. It usually appears after the insurance payment posts, as a leftover balance rather than a fresh charge.

What should I watch out for with Balance billing?

• A bill from an anesthesiologist, radiologist, pathologist, or assistant surgeon you never chose
• A leftover balance after emergency care — ask the provider which rule they used before sending it to you
• A bill that arrives before your plan finished the claim — ask them to bill insurance first and send you the EOB