Balance billing is when the provider submits a bill to insurance, e.g., ($60), insurance pays a portion ($48), and then the provider bills for the remainder ($12) to the patient.
I know Medicare prohibits this--they must accept amount the government allows, but what I'm wondering about is private insurance, specifically in Pennsylvania. I just had surgery and almost all the insurance payments were accepted. Example, the hospital bill was $79,000 and they accepted $63,000.
The top example is what happens when I go to my gastroenterologist for an OV. Visits before a surgery or procedure such as a colonoscopy are covered and insurance pays for it assuming I've met my deductible, but other routine checkups are denied by my insurance and I am billed the higher amount. This gripes me.
Anybody have a knowlege on this subject?