Accident & Health FundamentalsQuestion 20 of 315
Balance billing in a health plan context refers to:
a.The insurer's annual reconciliation of premiums
b.A bonus payment to in-network providers for meeting quality targets
c.A provider billing the patient for the difference between the provider's full charge and the amount the insurer pays
d.The patient's monthly premium bill
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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