Balance Billing

Balance billing is when the provider submits a bill to insurance, e.g., ($60), insurance pays a portion ($48), and then the provider bills for the remainder ($12) to the patient. 

I know Medicare prohibits this--they must accept amount the government allows, but what I'm wondering about is private insurance, specifically in Pennsylvania.  I just had surgery and almost all the insurance payments were accepted.  Example, the hospital bill was $79,000 and they accepted $63,000.

The top example is what happens when I go to my gastroenterologist for an OV.  Visits before a surgery or procedure such as a colonoscopy are covered and insurance pays for it assuming I've met my deductible, but other routine checkups are denied by my insurance and I am billed the higher amount.  This gripes me. 

Anybody have a knowlege on this subject?

You need to check into the specifics of your plan. I'm in PA too but my insurance is through DH and is completely different from what I can get through my employer -- both are BCBS. With my DH insurance we are balance billed but it depends on the doctor actually. Our primary and my GI(UPMC) balance bill for the difference of allowed and paid amounts. But my DH's endo doesn't bill us for any difference. It depends on your dr contract with the carrier.