What is a balance bill, and what should I do if my provider bills more than the fair and reasonable amount?

A balance bill is a medical bill from a healthcare provider billing a member for the difference between the Provider’s total billed charges less any portion of the medical need applied to the member’s Annual Unshared Amount together with any applicable Co-Share Amount, and any amount shared by members. For Liberty HealthShare members, this can happen when a provider's charge exceeds the "fair and reasonable" amount determined through the ministry's bill review process.

Why do balance bills happen even after a bill is repriced?

Liberty HealthShare uses a repricing vendor to ensure that medical charges fall within a fair and reasonable range for the type of care received in your area and the Medicare allowable amount for such a charge—a standard cost-containment practice designed to protect members from inflated billing.

However, Liberty HealthShare is not insurance and providers are not contractually required to accept the repriced amount. If a provider disagrees with the fair and reasonable determination they may bill you for the original, non-repriced balance.

How do I dispute a balance bill or request an itemized bill?

1. Start with an itemized bill. Request a line-by-line breakdown of every charge from your Provider. Medical bills frequently contain errors (such as duplicate charges, unbundled codes, or services not rendered) and identifying these is the first step in any dispute.

2. Upload your bill and all relevant information to the Patient Advocacy Center through Claritev. Liberty HealthShare’s third-party vendor, Claritev, gives members access to the PAC, who will negotiate balance bills with a provider on behalf of the member.