When a provider bills you for the difference between the provider’s charge and the allowed amount.
♦ Example: A provider’s charge is $100 and the allowed amount is $70, the provider may bill you for the remaining $30 if they are not in your plan's network.
• A preferred provider may not balance bill you for the remaining amount. An in network provider is an example of a preferred provider.
A provider that is out-of-network would be considered a non-preferred provider.
♦ Out-of-network providers are not under contract to accept your insurance company’s determination of what is reasonable.
As a result, they can and often do bill for the balance. Learn more about In Network vs Out-of-network.
• Provider Networks & Preferred Providers
• Why you should use in-network
• The beast named Surprise
• Surprise Medical Bills
• Balance Billing