What is a balance billing?

Balance billing occurs when a healthcare provider bills a patient for the amount not covered by the patient’s health insurance plan. This happens when a healthcare provider is not in-network with the patient’s insurance plan, or when a provider’s charge exceeds the amount covered by the patient’s insurance plan. When balance billing occurs in Washington, the healthcare provider must provide a written notice to the patient before they receive care. The notice must inform the patient that they may be balance billed if they receive care from an out-of-network provider. Additionally, the healthcare provider must accept the amount that their insurance plan pays as payment in full. When a patient is balance billed, there are a few options they have. They can file an appeal with their insurance company for reimbursement. Additionally, they can try to negotiate a lower payment with the provider. Lastly, they can pursue complaint resolution with Washington’s state insurance board, the Office of the Insurance Commissioner. Overall, balance billing occurs when a healthcare provider bills a patient for the amount not covered by the patient’s health insurance plan. Patients can file an appeal with their insurance company for reimbursement, try to negotiate a lower payment with the provider, or pursue complaint resolution with the Office of the Insurance Commissioner in Washington.

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