Balance billing for PPO plans
When a provider bills you for charges other than copayments, coinsurance, or any amounts Priority Health may pay towards your care, it's called "balance billing."
In-network providers aren't allowed to balance-bill you. They are under contract to accept the fees they negotiate with Priority Health.
Out-of-network providers may balance-bill you. We don't have contracts with them, so they can claim any amount they wish for your health care. This doesn't mean we will pay 100% of what they charge; we pay the maximum of what is reasonable and customary for the services you received based on the degree of skill required, the range of services provided by the facility where you went for the service, and regional variations in cost. After they receive our payment, they may bill you for the difference between the amount of their claim and what we paid.