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balance billing

   Also found in: Dictionary/thesaurus, Legal, Financial, Encyclopedia, Wikipedia, Hutchinson 0.02 sec.
balance,
n 1. equilibrium or harmony.
n 2. in dentistry, an occlusal equilibrium or facial esthetic harmony.
balance, acid-base,
n in metabolism, the balance of acid to base necessary to keep the blood pH level normal (between 7.35 and 7.43).
balance billing,
n the billing of a patient for the difference between the dental professional's actual charge and the amount reimbursed under the patient's dental benefits plan.
balance sheet,
n a condensed statement showing the nature and amount of a company's assets, liabilities, and capital on a given date. In dollar amounts the balance sheet shows the assets the company owns, the money it owes, and the ownership interest in the company of its stockholders.

balance billing
Managed care The practice of billing Pts in excess of the amount approved for payment by a health plan, Medicare, or private fee-for-service insurance. See Allowable charge, Nonparticipating physician.


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However, New Jersey regulations state that members of an HMO have the right to "be free from balance billing by providers for medically necessary services.
Action: California appellate court rejects long standing views of managed care plans ("Plans") (and their regulatory agency) regarding balance billing of covered individuals for care in emergency rooms by emergency room physicians who do not have contracts with the Plans.
Since the transaction occurs real-time, while the patient is there, any cost shares are communicated and collected at that time, eliminating the need for balance billing.
 
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