If you receive a bill from a provider for an amount higher than your total patient responsibility outlined by your plan on your explanation of benefits (EOB), this is likely a balance bill, which occurs when a provider bills you for the difference between the provider’s charge and the allowed amount.
For example, if the provider’s charge is $100 and the allowed amount is $70, the provider may bill you for the remaining $30. A contracted provider is never allowed to balance bill you for covered services.
While balance bills are common in the healthcare industry, they occur with less than 2% of all Sana claims because we pay fair provider reimbursements using our reference-based pricing formula.
Rest assured that when balance bills do happen, Sana has your back.
Sana was founded on the principle of putting members first and fixing what’s broken in healthcare, and this includes balance billing.
We know balance bills can be stressful for members, and we do everything we can to minimize what members have to do. As soon as you report your balance bill to Sana, our team gets to work to ensure you don’t owe more than the patient responsibility outlined in your plan, and your credit score won’t be affected*. We know it can feel overwhelming when a provider uses harassment or scare tactics to try to get you to pay their balance bill, but if you give Sana your trust and your patience, you can be assured that we’ll take care of the balance bill on your behalf.
If you receive a balance bill from one of your providers:
- Let us know right away. Email the bill as an attachment to firstname.lastname@example.org.
- Sana will reach out to your provider, confirm this is indeed a balance bill, and send it to our negotiation partner, Zelis, formerly known as Payer Compass, right away.
- Please have patience. Balance bills can take months to resolve. Some cases have been known to take a year, although that’s rare. In the end, you should never have to pay more than your patient responsibility, and we take every precaution to ensure your credit score is not compromised in the process.
- Don't pay your provider more than the patient responsibility outlined by your plan. If you're unsure what your patient responsibility is, you can ask Sana when you email us your balance bill. Also, never agree to a payment plan with your provider. This will either complicate the resolution process or cause Sana and our partners to lose our leverage entirely, rendering us unable to negotiate on your behalf. To date, we’ve successfully resolved 100% of known balance bills without a single member owing more than their plan's patient responsibility.
- Feel free to email us if you haven’t received an update from our partners in a month or so. We’ll work to connect you with our partners to get you answers as soon as possible. If your provider harasses you at all for payment in the meantime, feel free to ignore or you can assure them “my insurance company is in contact with your billing team to resolve this balance bill as swiftly as possible. In the meantime, I won’t be paying more than my patient responsibility as outlined by my medical plan.”
We know balance bills are, at best, frustrating and, at worst scary, stressful, and time-consuming. There are a lot of things we are working to fix about healthcare, and balance bills are definitely one of them. We’ve partnered with industry experts who take care of your balance bill every step of the way — even if it seems to be moving slower than we’d like. In the meantime, there’s no need for you to respond to collection attempts from your provider or worry about the integrity of your credit score. Feel free to check-in if you’re ever feeling worried or need an update. We got you.
Visit our balance bill FAQs to learn more.
* There is a <1% chance that a balance bill will affect your credit score, provided you report it to Sana when you receive it. We assign your case to our negotiation partner, Zelis, formerly known as Payer Compass, who takes precautions to avoid any impacts to your credit scores across all three bureaus. Their negotiation process is tailored to ensure a settlement occurs within 180 days (the waiting period before a medical debt reported by a collection agency may appear on someone’s credit report) of your account being referred to collections and we work with credit agencies to ensure they are aware any such charges are being disputed. In addition, we work with our legal partner, The Phia Group, who provides an extra level of protection by giving you outside counsel representation if needed to support more difficult and escalated balance bill cases in the rare instances when they occur.