Hello folks!
I'd like to use a recently approved ER claim as an example.
Bill = $3,100
Discount = 0
Allowed Amount = $300 (Applied to deductible)
Plan paid = 0
Amount I owe = $3100
Healthcare.gov states a balance bill is (Total Bill) - (Allowed Amount). In my case the balance bill would be $2800.
However, another popular definition is (Total Bill) - (What insurance paid). In my case it would seem like the balance bill would be the entire bill, since insurance paid $0. Doesn't sound right.
"Out-of-network doctors and facilities may be allowed to bill you for the difference between what your plan agreed to pay and the full amount charged for a service. This is called “balance billing.” "
Source, my insurance Anthem BCBS
The ER facility does not balance bill, so I am trying to plan what I will owe as $300 is more manageable than $3100. The remaining $2800 was not covered by insurance.
Thank you in advance!
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