[20150723]IF10263_私人健康保险计划中的余额计费.pdf

https:/crsreports.congress.gov July 23, 2015Balance Billing in Private Health Insurance PlansWhat Is Balance Billing? Balance billing is when a health care provider bills a consumer for charges (other than cost sharing) that exceed the health insurance plans payment for a covered service. Key Terms Charge: The dollar amount a provider sets for services rendered before negotiating any discounts. Negotiated Payment: The maximum amount on which payment is based for covered health care services. The payment may be negotiated by the health plan or the consumer. In-Network: The facilities, providers, and suppliers with which a health plan has contracted to provide health care services. Out-of-Network: The facilities, providers, and suppliers with which a health plan has not contracted to provide health care services. Premium: The amount paid for health insurance, often on a monthly basis. Cost Sharing: Also referred to as out-of-pocket costs for the consumer. The amount an insured consumer pays for health care services according to the terms indicated in the health plan. A plans cost-sharing requirements may include deductibles, coinsurance, and co-payments. Coinsurance: The share of co