A situation in which Private Fee-for-Service Plan providers (doctors or hospitals) can charge and bill you 15% more than the plan's payment amount for services.
The difference between the billed amount and the amount approved by Medicare.
Billing the patient or beneficiary for any fee in excess of the amount allowed by the insurance carrier.
billing a patient for the difference between the dentistâ€(tm)s actual charge and the amount reimbursed under the patientâ€(tm)s dental benefit plan.
The practice of a provider billing a patient for all charges not paid for by the insurance plan, even if those charges are above the plan's UCR or are considered medically unnecessary. Managed care plans and service plans generally prohibit providers from balance billing except for allowed co-payments, coinsurance, and deductibles. Such prohibition against balance billing may even extend to the plan's failure to pay at all (e.g., because of bankruptcy).
When subscribers are billed for the difference between what the insurer pays and the fee that the provider normally charges.
Ohio Med. Non-network providers may bill the patient the difference between Medical Mutual’s allowed amount and actual charges. Network providers will not balance bill you.
A bill for the difference between what your insurer will pay and what the physician charges for a service. Basic Hospital Insurance – have low benefit (do not cover much) and little or no deductible. For example, a policy might cover only up to 30 or 90 days in a hospital and xx number of doctor visits per year.
Balance billing may occur when the out-of-network providerâ€(tm)s charge exceeds a health planâ€(tm)s allowable charge. The member may be required to pay the difference between the health plans allowable charges and the out-of-network providerâ€(tm)s requested charge.
The practice when medical care providers (such as doctors, hospitals or other medical practitioners) bill the insured for the portion of the bill not paid by the insurer. The practice is prohibited by Medicare and some managed care companies.
A billing practice in which you are billed for the difference between what your insurer pays and the fee that the provider normally charges. Balance billing is prohibited under most HMO contracts in New York, but may arise when you use services of out-of-network providers under a PPO or POS arrangement.
Physician charges in excess of Medicare-allowed amounts, for which Medicare patients are responsible, subject to a limit. Can also apply to other health insurance plans.
The process of a provider trying to collect from a patient the difference between what is allowed per the Ohio Health Choice contract and what they normally charge. Balance billing is not permitted when an Ohio Health Choice member and a network provider are involved.
The practice of a provider billing a patient for all charges not paid for by the insurance plan, because those charges are above the plan's UCR (usual, customary, and reasonable) practice or may be considered medically unnecessary; plans are increasingly prohibiting providers from balance billing except for allowed co-payments, coinsurance, and deductibles.
The practice of a provider billing a patient for all charges not paid for by the insurance plan, even if those charges are above the plan's Usual, Customary, or Reasonable (UCR) charges.
Provider practice of billing the patient for the difference (or balance) of charges above the amount reimbursed by the health plan. Managed care plans commonly prohibit providers from balance billing except for allowed copayments, coinsurance and deductibles.
Doctors who are not contracted with a managed care plan may charge more for their services than the amount the plan pays. When this happens, the doctor may hold the patient responsible for the difference.
A method of billing patients whereby they are charged for all costs above the allowed amount.
The portion of a provider's charges for which the insured person is billed after the insurance company pays the “usual and customary” charges it deems appropriate for the services received (after the person has paid any applicable co-payment or coinsurance).
a provider's billing of a covered person for charges above the amount reimbursed by the health plan (difference between billed charges and the amount paid). This may or may not be appropriate, depending upon the contractual arrangements between the parties.
A specified amount you may be billed and owe to a non-participating/ non-preferred physician, health care practitioner or facility. The amount is the difference between what the health plan pays along with your co-insurance, copayment and any deductible and the non-participating/ non-preferred physician's, health care practitioner's or facility's charge.
The practice when medical care providers (such as doctors, hospitals or other medical practitioners) bill you for the portion of the bill not paid by your insurance company. The practice is prohibited by Medicare and some managed care companies.
If a nonparticipating dentist's fees are more than Delta Dental allows for a service, the dentist can bill the patient for the difference. Delta Dental participating providers do not bill the patient for the difference and only charge the patient for copayments and deductibles.
Under the Federal Appropriations Act of 1993, you cannot be billed for the remainder or 'balance' of the provider charges after your civilian health insurance plan or TRICARE has paid their obligation. Federal law states that you are not legally responsible for amounts in excess of 15% above the TRICARE allowable charge even if the provider is not contracted and does not accept assignment of benefits.
The practice of billing a patient for the difference between the actual charge and what the provider receives from the Blues and the member copayment.
Billing by a provider who charges more than the CHAMPUS-allowable fee. By law, non- participating providers can't bill patients more than 15 percent above the CHAMPUS-allowable charge. The patient must then pay the 15 percent in addition to their normal cost share.
The process of a provider trying to collect from a patient, the PPO Discount, the difference between what is allowed per the 4MOST contract and what they normally charge. Balance Billing is not permitted when a 4MOST member and a Network provider are involved.
The practice of sending a bill to the patient for the difference between the original charge for health care services and the amount allowed and paid by the insurance plan.
The amount a provider can bill a beneficiary over and above what Medicare pays. Generally this amount is limited to 115% of what Medicare approves. In Medicare managed care plans, there should not be any balance billing. However, in traditional Medicare and private fee-for-service plans, there may be balance billing unless a physician "accepts assignment".
Billing a patient for charges not paid by their insurance plan because the charges are above the Usual and Customary Rate or because the insurer considered a procedure medically unnecessary.
When a provider is trying to collect from a patient, the balance billing is known as the difference between what is allowed or covered by the patient’s health insurance company and what the medical provider charges. Balance billing is not permissible when an Encore network provider is used.
Sometimes referred to as hold harmless agreements. A contractual arrangement with dentists that limit excess charges and protect patients from inappropriate billing.
Non-participating provider practice of billing the patient for any difference between the provider's billed charges and the patient's insurance plan maximum allowance (indemnity or PPO).
If a provider chooses not to accept assignment, he or she can "balance bill" the patient for the portion of the charge not recognized by Medicare.
The practice of billing you for the fee amount remaining after your health insurer's payment.
The practice of billing patients for all charges over the physician rate paid by insurers. Many managed care plans prohibit this practice.