balance billing


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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.

bal·ance bill·ing

(bal'ăns bil'ing)
Sending a financial statement to the patient for the remainder of the amount charged and remaining unpaid after the third-party payer has submitted their financial contribution.

bal·ance bil·ling

(bal'ăns bil'ing)
Sending a financial statement to the patient for the remainder of the amount charged and remaining unpaid after the third-party payer has submitted their financial contribution.
References in periodicals archive ?
the UCR and Medicare rate) to determine reimbursement, excessive balance billing for emergency care, lack of disclosure for nonemergency care, and difficulty submitting claims.
Change the prohibition on balance billing, and you will have solved the problem.
That appears to be the intent of this bill - it's why the bill's supporters torpedoed attempt after attempt to insert consumer protections against balance billing during the legislative process.
Use of balance billing varies across physician specialties (Centers for Medicare & Medicaid Services, 2003).
Maintain the BBA requirement that the contract a beneficiary signs clearly indicates that: claims will not be submitted to Medicare by either the physician or the beneficiary; the beneficiary is responsible for the full cost of the privately contracted services; balance billing limits do not apply to contracted services: Medigap coverage will not be available for contracted services; and the services to be performed could be paid for by Medicare if provided by another physician.
The court decision sends a strong message to anyone engaged in balance billing that this sharp practice has been officially declared to be illegal and that these cynical billing practices must end immediately.
My goal, in addition to gathering information on the issue of surprise balance billing, is to get ideas on how to deal with this problem and draw input from everyone involved," said Commissioner Miller during her opening statement at the State Museum in Harrisburg.
His comments followed a letter he sent to Kitzman expressing his concern over her decision to propose changes to the so-called balance billing rule passed by her predecessor.
Employers have as much interest as do physicians and patients in removing the balance billing prohibition.
For example, most insurers have clauses that prohibit balance billing and discrimination and some insurers have chosen to invoke those clauses against concierge practices, he said.
This meant that providers were prohibited from balance billing their low-income Medicare beneficiaries.
Senate Bill 981 would have banned the practice of balance billing but was fraught with problems that would have added significant medical cost inflation to the market place at a time when individuals, families and employers are struggling to pay for health benefits.