What is "balance billing" in the context of healthcare claims?

In the context of healthcare claims, balance billing refers to the practice of charging the patient for the difference between the total charge for services rendered and the amount that the insurance company has paid. This occurs after the insurance claim has been processed. Typically, patients are billed for the remaining balance when the healthcare provider does not have a contractual agreement with the insurance company that prohibits such billing.

This practice is particularly relevant in situations where the provider is out of network for a patient's insurance plan, leading to potentially higher out-of-pocket expenses for the patient. Understanding balance billing is crucial as it highlights the financial responsibilities patients may face after insurance claims have been settled.

The other options relate to different aspects of the healthcare billing and reimbursement process but do not accurately define overall balance billing. For instance, charging a higher rate for services rendered pertains more to pricing strategy than to billing practices post-insurance claims. Verifying a patient's insurance coverage happens before services are rendered and is a part of the administrative process rather than billing after the fact. Establishing contract terms with health plans relates to provider agreements and negotiations rather than the specific act of balance billing.