Balance billing definition

Balance billing means charging or collecting an amount in excess of the Medicaid, Medicare, or contracted reimbursement rate for services covered under a Medicaid, Medicare or employer sponsored beneficiary’s plan. “Balance Billing” does not include charging or collecting deductibles or copayments and coinsurance required by the beneficiary’s plan.

Balance billing means charging a person, on whose behalf a workers' compensation insurance carrier or self-insured employer is obligated to pay medical benefits under this chapter or Chapter 3, Utah Occupational Disease Act, for the difference between what the workers' compensation insurance carrier or self-insured employer reimburses the hospital for covered medical services and what the hospital charges for those covered medical services.

Balance billing means the practice of a provider billing for the difference between the provider’s charge and the health carrier’s allowed amount.

Examples of Balance billing in a sentence

• Balance billing is defined as billing a beneficiary the difference between 115% of TRICARE allowed amount and the billed charges on a claim, less the copay or cost- share.

• Balance billing is the practice in which Medicare Network Pharmacy Providers seek to bill a QMB for MedicareCost-Sharing.

• Medicare-Medicaid Program (MMP) Balance Billing:• Balance billing is not allowed.• Per federal law, Members who are dually eligible for Medicare and Medicaid shall not be held liable for Medicare Part A and B cost- sharing.• The provider is responsible for verifying eligibility and obtaining approval for those services that require Prior Authorization.• Under no circumstance shall a Member be liable to the provider for any sums that are the legal obligation of Molina.

• Balance Billing Balance billing is when an out-of-network provider/facility bills you for the difference between the provider/facility’s charge and the Plan’s Reasonable and Allowable Amount.

• Balance billing a Molina Member for Covered Services is prohibited, other than for the Member’s applicable copayment, coinsurance and deductible amounts.

More Definitions of Balance billing

Balance billing means a health care provider’s demand that a patient pay a greater amount for a given service than the amount the individual’s insurer, managed care organization, or health service corporation has paid or will pay for the service.

Balance billing means the practice of an air ambulance provider billing for the

Balance billing means the practice of an air ambulance provider billing for the difference between the air ambulance provider's charge and the health care insurer's allowed amount.

Balance billing means charging a covered person who is insured through a health benefit plan that

Balance billing means the practice by a provider, who does not participate in an enrollee’s health benefit plan network, of charging the enrollee the difference between the provider’s fee and the sum of what the enrollee’s health benefit plan pays and what the enrollee is required to pay in applicable deductibles, co-payments, coinsurance or other cost-sharing amounts required by the health benefit plan.

Balance billing means the practice of charging an enrollee in a health benefit plan that uses a provider network to recover from the enrollee the balance of a non-network health care provider’s fee for service received by the enrollee from the health care provider that is not fully reimbursed by the enrollee ’s health benefit plan.

Balance billing means a non-network provider billing you for the difference between the provider’s charge for a service and the eligible service expense. Network providers may not balance bill you for covered service expenses.