Certified Application Counselor Practice Test

What does balance billing refer to?

1. A provider billing you for the total amount of care

2. A provider billing you for the difference between the charged amount and the allowed amount

3. A provider charging only what the insurance approves

4. A provider refusing to accept insurance payments

The correct answer is: A provider billing you for the difference between the charged amount and the allowed amount

Balance billing specifically refers to the practice of a healthcare provider billing a patient for the difference between the amount they charged for a service and the amount the insurance company has allowed as payment. This typically occurs when a provider is not in-network with a patient's insurance plan, allowing them to charge more than what the insurance will cover. In situations where a patient has received services from an out-of-network provider, the insurance may only cover a portion of the total billed amount. The provider is then able to bill the patient for the remainder. This is why the definition provided in the correct answer aligns with the established understanding of balance billing in the context of healthcare and insurance. The other options describe different billing scenarios but do not accurately capture what balance billing entails. One talks about a provider billing for the total amount, another mentions charging only what insurance approves, while the last option implies a refusal to accept insurance at all, which are not aspects of balance billing specifically.