Definitions for "Balance Billing"
Billing a member or other responsible party for the difference between the insurer's payment and the actual charge.
amounts charged by Non-Preferred Providers above the allowable amount, for which members are responsible.
The practice of billing a patient for the fee amount remaining after insurer payment and co-payment have been made. Under Medicare, the excess amount cannot be more than 15 percent above the approved charge.
For specific stop-loss insurance, it is the point at which the stop-loss insurance carrier begins to reimburse the employer based upon the individual's total of claims paid within a policy year.