What does "balance billing" refer to?

Balance billing refers specifically to the practice where a healthcare provider bills a patient for the difference between the provider's charges and the amount covered by the insurance. This typically occurs when the provider is not in-network with the patient's insurance plan, leading to scenarios where the total billed amount exceeds what the insurance is willing to pay. The patient is then responsible for paying this balance directly to the provider.

In the context of health insurance, this practice can lead to unexpected out-of-pocket costs for patients, which is why understanding balance billing is crucial. It's important for patients to be aware of whether their healthcare provider is in-network to avoid such situations.