Articles Posted in Balance Biling

Beware of Balance Billing

Beware of Balance Billing

Ed Smith is a Sacramento Personal Injury Lawyer. Health insurance is a complex topic, but most adults understand the basics of how the average policy is supposed to work. Suppose that Jorge goes to an “in-network” medical provider (meaning a medical provider with whom Jorge’s health insurer has agreed to certain contractual rates for services). Jorge receives services that total $700. He pays his $25 copay and goes on his way (assume Jorge has no deductible). The medical provider discounts Jorge’s medical bill to the rate it had agreed to with Jorge’s insurer, and then the insurer pays the provider the agreed upon rate.

Suppose further that Jorge goes to a medical provider that is not within his health insurance’s network of providers. The medical provider in this case can charge Jorge the full $700. Depending on the terms of the health insurance contract between Jorge and his insurer, the insurer may pay a portion of this bill. The medical provider would then bill Jorge for the balance that remains afterward. This practice is known as “balance billing.” Continue reading ›