1. Health

Balance Billing

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Updated July 01, 2014

Definition:

Balance billing is the (usually) illegal practice of hospitals, clinics, doctors offices and other medical facilities billing patients for the balance between what they want to charge their patients for services and what the insurance company has already reimbursed them.

The practice of balance billing is illegal for all Medicare patients. It is also illegal in 47 states when patients with private insurance seek care from doctors and facilities that are under contract with their insurers.

The exception is this: if a provider tells the patient ahead of time that a service probably won't be covered by the insurance / payer, then balance billing can take place, whether or not the payer actually does reimburse any of the total amount due to the provider for the service.

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