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Balanced Billing for Medical Billing Disputes

Balanced billing arbitration is an increasingly popular method of resolving disputes usually between a provider and an insurance company. One of the frequent purposes of this is to provide protection for the patient and so it is also known as Surprise Billing Arbitration in some jurisdictons.


What is baseball arbitration and why is it called, that?

Baseball arbitration originated from baseball and player compensation. When the parties could not agree on compensation, each put in their final or best offer, and an arbitrator decided what was a fair value. The one closest to the arbitrator decision then won their final offer.

How does this work for Medical Billing?

The way this works varies some by jurisdiction, as to which factors and arguments an arbitrator may consider, but the final process works approximately like this. After reviewing the relevant facts and argument, the arbitrator decides what the fair value or fee is. Let's consider a case where party A wants to collect $1000 and party B wants to pay $800. If the arbitrator decides the value is $900.01 or more, then party A wins, and the fee of $1000 should be paid. If the arbitrator decides the value is up to $899.99, then then party B wins, and the fee to be paid is $800.

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