Balance billing
Updated September 30, 2026
Definition
When a provider bills you for the difference between its full charge and your plan's allowed amount. In-network providers generally can't do this for covered services.
Balance billing is when a provider bills you for the gap between its price and the amount your health plan allows. It usually comes from out-of-network providers, since they haven't agreed to your plan's rates. In-network providers generally can't balance bill you for covered services.
For example, say an out-of-network provider charges $1,000 and your plan's allowed amount is $600. After your plan pays its part, the provider may bill you for the $400 gap, on top of your normal share.
Federal law limits this in many cases. The No Surprises Act protects you from balance bills for most emergency care, air ambulance rides, and some care at in-network hospitals. State rules may add more protections. To check your bill, see does the No Surprises Act apply to my bill.
Related terms
Guides that use this term
- GuideDoes the No Surprises Act apply to my bill?The No Surprises Act limits many surprise out-of-network bills. See when it applies, what it doesn't cover, and what to do if you get a surprise bill.
- GuideWhy is my medical bill higher than my EOB?Your bill asks for more than your EOB says you owe? See the usual reasons, a worked example, and the steps to get a corrected bill before you pay.
Sources
- Balance billing (glossary), HealthCare.gov. Accessed September 30, 2026.
- Know your rights: health insurance and surprise billing, Centers for Medicare & Medicaid Services. Accessed September 30, 2026.
This is general information, not legal or medical advice. Rules can depend on your plan and your state. Romi Care isn't an insurer, law firm, collection agency, or government program.