Accident & Health FundamentalsQuestion 20 of 315
Balance billing in a health plan context refers to:
a.A bonus payment to in-network providers for meeting quality targets
b.The patient's monthly premium bill
c.The insurer's annual reconciliation of premiums
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.
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Sen Lin, PrepPass Founder · 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)