Balance billing charges the patient the gap between billed charges and payer reimbursement. The No Surprises Act prohibits it for out-of-network emergency services and for out-of-network care at in-network facilities.
Many states restricted balance billing before the federal law.
Alternative Names:
Balance Billing, Surprise Billing Claim
Why it Matters?
These claims now proceed against a substantially narrowed permitted scope, and providers billing patients in prohibited circumstances face penalties. In injury litigation, balance bills were historically the mechanism producing large medical specials from out-of-network emergency treatment, and their restriction has reduced that component. Where a balance bill was improperly issued, its recoverability as damages is itself questionable.
Frequently Confused with
Related terms
Frequently asked questions
When is balance billing prohibited?
Are improper balance bills recoverable as damages?
