Balance billing refers to the practice of a healthcare provider billing a patient for the portion of a medical expense that is not covered by the patient’s insurance. This means that if a patient’s insurance plan has a negotiated rate with a healthcare provider, and the provider charges more than that rate, the patient may be responsible for paying the difference, or “balance,” out of pocket. This can happen when a patient receives care from an out-of-network provider, or when a service is not covered by their insurance plan.
Balance billing is considered to be problematic for a number of reasons. For patients, it can result in unexpected and unaffordable medical expenses. It can also lead to confusion and frustration when patients are unsure of how much they will be responsible for paying, or when they receive conflicting bills from different providers.
For healthcare providers, balance billing can also be detrimental. It can harm the provider-patient relationship and damage the provider’s reputation, as well as subjecting the provider to legal disputes .
Additionally, balance billing can also lead to issues of equity and accessibility. It can disproportionately affect patients with lower incomes or those who live in areas with fewer in-network providers, making it harder for these patients to afford and access the care they need.
For these reasons, some states like Florida have enacted laws to regulate or prohibit balance billing, as it violates FCCPA by collecting and billing in a deceptive or unfair manner to patients. If you believe that your provider is balance billing you, then please fee free to contact us at The Russo Law Firm as we FCCPA experts and would be happy to investigate your bill for you. If the provider has illegally billed you, then you could be entitled to $1000.00 in statutory damages among other benefits.