balance billing

Medical term Administrative Assisting

A provider billing the patient for the difference between its charge and the plan's allowed amount; network providers may not do this for covered services.

Sources

Glossary of Health Coverage and Medical Terms (Uniform Glossary; emergency medical condition, urgent care, referral, preventive care) · Centers for Medicare & Medicaid Services

Related terms

allowed amountThe maximum a plan will pay for a covered service; also called the eligible expense or negotiated rate.
networkThe providers and facilities a health plan has contracted with to provide care.
appealA request that the health plan review a decision denying a benefit or payment.
birthday ruleA coordination-of-benefits rule: a child covered by both parents uses first the plan of the parent whose…
charting by exceptionDocumenting only findings that differ from established normal standards.
claimA request to a health plan for payment for services provided.
coinsuranceThe patient's share of a covered service, figured as a percentage of the allowed amount.
copaymentA fixed dollar amount the patient pays for a covered service, usually at the visit.
deductibleThe amount the patient owes for covered services each coverage period before the plan starts to pay.
double-bookingScheduling two patients in the same time slot with the same provider.

balance billing

Related terms

Study Administrative Assisting