BALANCE BILLING Meaning and
Definition
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Balance billing refers to a billing practice in the healthcare industry where a healthcare provider, such as a doctor or hospital, bills a patient for the difference between the provider's customary charges and the amount covered by the patient's health insurance. In other words, it is the amount that a patient is responsible for paying out-of-pocket after their insurance company has paid their portion.
Typically, insurance companies negotiate rates with healthcare providers, and if a patient receives services from a network provider, the insurance company will pay a predetermined rate for those services. However, if a patient chooses to receive treatment from an out-of-network provider or in certain situations where the patient has no control over the provider, such as in emergency situations, the provider's charges may exceed the negotiated rate. This results in the patient receiving a bill for the remaining balance, which is known as a balance bill.
Balance billing can often lead to financial hardships for patients, as they may be responsible for paying significantly more than they anticipated. It is especially common in the United States, where healthcare costs are generally higher compared to other countries. Some states have implemented laws to protect patients from excessive balance billing, such as setting limits on the amount providers can charge or prohibiting balance billing altogether.
In summary, balance billing refers to the practice of billing patients for the difference between a healthcare provider's charges and the amount covered by their insurance, often resulting in unexpected out-of-pocket expenses for the patient.
Etymology of BALANCE BILLING
The etymology of the word "balance billing" can be understood by breaking it down into its constituent parts:
1. Balance: The word "balance" comes from the Middle English word "balaunce", which originated from the Old French word "balancier". It ultimately derives from the Latin word "bilanx", meaning "two-scaled".
2. Billing: The word "billing" comes from the Middle English word "bile" or "bille", which means "a written statement or invoice". It is related to the Old English word "byllan", meaning "to submit a bill".
Therefore, "balance billing" refers to the act of presenting an invoice or statement that represents the balance owed by a patient to a healthcare provider after insurance coverage has been applied.
