Accident & Health FundamentalsQuestion 20 of 716
Balance billing in a health plan context refers to:
a.A bonus payment made to in-network providers for meeting the quality and cost targets set out in the plan's contract
b.The monthly premium statement a health plan sends to the enrolled subscriber before each month of coverage begins
c.The insurer's annual reconciliation of premiums collected against the claims paid during the plan year
d.A provider billing the patient for the difference between the provider's full charge and the amount the insurer pays
Explanation
Balance billing occurs when a provider bills the patient for the difference between the provider's total charge and the amount the insurer pays as the allowed amount. In-network providers typically agree not to balance bill; out-of-network or surprise-billing scenarios are addressed by laws like the federal No Surprises Act and California AB 72.
Law Reference: Network terminology – balance billingThis topic, taught in full in the California Life & Health Insurance Producer Exam guide. California Life & Health Insurance Producer Exam — Complete Study Guide (2026) — PDF + EPUB, $19.99 · 14-day refund →
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PrepPass team · Verified against California Life & Health Insurance License Exam · How we review
Reviewed by John Zihao Zhang — California-Licensed Life Insurance Agent (CA Dept. of Insurance License #4396095 — verify)