There are many good reasons for your employees to get health care services from in-network doctors, including saving money. When they are seen by out-of-network doctors, there may be extra charges, called “balance billing.” Here’s how it works.

When a doctor participates in the Quartz network, he or she agrees to charge patients a specific rate for services (the “Allowed Amount”). The Allowed Amount is the basis for Quartz’s benefit payment and the member’s cost-sharing payment.

When someone gets care from an out-of-network provider and that provider charges more than the Allowed Amount, Quartz will compare charges from other doctors in the area for the same service to decide what is a usual, customary and reasonable (UCR) charge. Quartz will pay the doctor at the UCR rate.

If there is still a difference between cost of the service and the amount paid by Quartz, the provider may bill the patient for the difference. This is known as balance billing. These charges do not apply to the plan’s maximum out-of-pocket costs.

To avoid balance billing, patients should try to see doctors who are in their plan’s provider network. QuartzBenefits.com/findadoctor is a handy resource for finding network providers or you can call Quartz Customer Service at (800) 362-3310. TTY users, call 711 / (800) 877-8973.

balance billing