Balance Billing

If a Medicare Private Fee-for-Service Plan’s provider (doctor or hospital) charges you for more than the plan’s payment amount for services, this is called balance billing. balance billing to pay for prescription drug planThis overcharge cannot be more than 15% of the amount approved by Medicare. Depending on your state, balance billing could be less than 15%. In order to balance bill the provider needs to have a written contract with the Medicare Private-Fee-for-Service Plan or who have met certain company conditions to ensure a contract.

Even though the Plan allowed providers to “balance bill,” the provider still accepted the Medicare-approved amount as payment in full.