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balance billing

What Does Balance Billing Mean?

Balance billing is when a provider or hospital bills you for the difference between their original bill and the amount your insurance paid plus any copay, coinsurance, and deductible payments.

Using an in-network provider will usually protect you from this happening because their agreements with the insurance plan are limited to a total payment for covered services to a negotiated or “allowable” rate.

For example, if your provider charges you $200, but the allowable amount is $100, the provider agrees to perform the service for $100 with the insurance coverage. Your insurance company may pay part or all of the bill depending on your copay, coinsurance, and deductible.

The best way to avoid balance billing is to make sure your providers are in-network and carefully read through your health insurance explanation of benefits, so you don’t get any surprises.

If you ever have questions about a bill, give us a call. Our claims department will review the bill and handle the situation for you.

Cosmo Insurance Agency is a full-service independent insurance agency based in Hackensack (Bergen County) and Lakewood (Ocean County), New Jersey that offers an all-encompassing range of insurance options for both individuals and businesses. Cosmo keeps its promise to assure an efficient and creative approach to the services we offer. Each of our clients experience a personalized and long-term relationship with us. Our New Jersey based team of health brokers guides our clients in helping them choose the most cost-effective options. By incorporating our knowledge of the insurance guidelines for healthcare, employee benefits, life insurance, self-insurance, dental, disability, and long term care insurance, we keep our clients up-to-date with affordable plans that cover all their specific insurance needs.