What does "balance billing" mean in a healthcare context?

Balance billing refers specifically to the practice where a healthcare provider charges a patient for the difference between what the provider bills for services and what the patient's insurance plan actually pays for those services. This often occurs when the provider's billed amount exceeds the reimbursement rate set by the insurance.

In practice, when a patient receives care from an out-of-network provider, the provider may bill the patient for the remaining balance that their insurance does not cover. This scenario is common in situations where the healthcare provider has not agreed to the insurance company's fee schedule, potentially leading to higher out-of-pocket expenses for the patient.

Understanding this term is crucial for patient access specialists, as it directly impacts patient financial responsibilities and can influence billing practices and patient satisfaction. The other options describe different billing practices but do not encompass the specific concept of balance billing. For instance, charging a patient for services not covered by insurance pertains more to administrative billing rather than balance billing itself, while charging a flat rate is usually associated with bundled payments or fixed fees without considering the insurer's reimbursement rates.