Balance Billing

min read
A- A+

Balance Billing


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.

Related content

Networks - In & Out

• Provider Networks & Preferred Providers

• Why you should use in-network

Surprise Billing

• The beast named Surprise

• Surprise Medical Bills

• Balance Billing