What is a balance billing?

Balance billing is a process related to health insurance law in Hawaii. It occurs when a health care provider bills a patient for the difference between the cost of a health care service and the amount paid by the patient’s health insurance. This means the patient is responsible for paying out of pocket for the difference. For example, a patient pays their co-payment for a doctor appointment up front, and then the health care provider submits the information to the patient’s health insurance. The health insurance company deems the service to be out of network and pays a lower rate than the cost of the appointment and the patient receives a bill from the provider for the difference. This is an example of balance billing. In Hawaii, balance billing is illegal for certain types of insurance plans. These plans include Medicaid, the Children’s Health Insurance Program, and any health plan that has been issued by a non-profit health service corporation. If a provider balance bills a patient on any of these plans, they are in violation of the law. Balance billing is a process that, if not properly handled, could result in patients being overcharged for services. It is important to understand how it works and to know the laws in Hawaii related to balance billing. This way, patients can be informed about the process and protect themselves from being taken advantage of.

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What is a balance billing?

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