If you receive a surprise medical bill, we're here to help.
Below are answers to common questions about balance bills and our resolution process.
What is a balance bill?
A balance bill occurs when a provider chooses not to accept an insurance payer's rate, billing patients for the difference. Balance bills can happen to members of all insurance carriers.
Sana's payment rates are based on current fair market rates that providers typically accept. As a result, fewer than 2% of claims balances are billed, and to date, we've successfully resolved 100% of known balance bills.
Do I have to pay my balance bill?
No. Our in-house team and balance bill resolution partners work hard to ensure you only have to pay within your plan's patient responsibility, as defined in your Explanation of Benefits (EOB).
To get a balance bill resolved, please take these actions as soon as possible:
- Pay the patient responsibility outlined in your Explanation of Benefits (EOB)
- Send Sana the bill with proof of payment
Why do I have to pay my patient responsibility before Sana can resolve the balance bill?
Balance bill negotiations can only start once providers have received payment in full per your Explanation of Benefits (EOB). If you have yet to meet your patient responsibility, the bill is not considered a balance bill.
What if my balance bill is sent to collections? Will this affect my credit score?
There is a <1% chance that a balance bill will affect your credit score.
If sent to collections, Sana will contact the collections agency and let them know that this balance bill is in negotiations to place a hold on your account to protect your credit score.
Did you know?
- Unpaid medical collection debt won't appear on credit reports for the first year, allowing time for health insurers and providers to address balance bills.
- Equifax (EFX), Experian (EXPGF), and TransUnion (TRU) no longer include medical debt that is sent to collections on consumer credit reports once it has been resolved or paid off.
- Medical collection debt of less than $500 is excluded from credit reports.
What do I do if my provider contacts me to pay the total amount of the balance bill?
Tell them, "My insurance company is working with your billing team to resolve this balance bill quickly. Until resolved, I can only pay the patient responsibility as outlined by my Explanation of Benefits."
To ensure we have the leverage to negotiate the balance bill:
- Do not pay any portion of the bill beyond your patient responsibility.
- Do not set up a payment plan for the balance bill.
- If the provider withholds care, please reach out to Sana for assistance.
What is Sana doing behind the scenes to resolve my balance bill?
Our in-house balance bill team works closely with our reference-based pricing partner, Zelis, and our claims negotiations partners, The Phia Group and Southern Health Lawyers (SHL); who are experts in resolving balance bills.
How long does a balance bill take to resolve?
Balance bills can take several months to resolve, depending on the provider's responsiveness. Feel free to contact Customer support if you have any questions during the process.
Is a balance bill the same as a surprise bill?
These terms are often used interchangeably and generally mean the same thing. In early 2022, the No Surprises Act was passed, offering protections against surprise billing. Those protections, however, are limited to non-contracted emergency services, non-contracted providers at contracted facilities, and services from non-contracted air ambulance service providers. Details are included with your explanation of benefits (EOB) for qualifying services.