AHIP Practice Exam 2025 – All-in-One Resource to Master Your Certification!

The phrase "balance billing" specifically refers to the practice where a healthcare provider bills a patient for the difference between the total charge for a service and the amount that the insurance company reimburses. This situation typically arises when a provider is out-of-network for a patient’s insurance plan. In such cases, the healthcare provider may charge the patient for the leftover balance after the insurance payment, hence "balance billing."

Understanding this concept is crucial because it relates to how charges and payments are handled between patients, providers, and insurance companies. In many cases, balance billing can lead to unexpected out-of-pocket costs for patients if they are not aware that their provider does not accept the insurance payment as full payment for services rendered. Thus, grasping the implications of balance billing can help patients navigate their healthcare expenses more effectively.