Balance billing is not a well-known term, but if you may have experienced it, especially if you’ve had a medical emergency and received emergency services.
Simply put, balance billing is when a medical provider sends you a bill for the remainder of an invoice that your insurance provider did not cover. This happens commonly with out-of-network providers – medical providers who are not under any contracts with your insurance provider and who will cost more to see.
For example, say you have an emergency appendectomy. Depending on the situation, you probably don’t have time to research a provider or find out whether everyone involved in your appendectomy is in-network – you’re concerned with getting to the emergency room as fast as you can. If the anesthesiologist, the hospital, or someone else involved with the procedure is out of network, you may receive an unexpected bill in the mail after the procedure.
The good news is that as of 2022, you have some protection against these kinds of bills if you receive emergency care, non-emergency care from out-of-network providers in an in-network facility (e.g., if your theoretical anesthesiologist was out of network even though the hospital itself is in network), or air ambulance services from an out-of-network provider. Click HERE to learn more about what rights you have under the No Surprises Act and HERE to ask questions or get help regarding surprise medical bills.
What is a “surprise medical bill” and what should I know about the No Surprises Act? | Consumer Financial Protection Bureau (consumerfinance.gov)
Balance billing – Glossary | HealthCare.gov