Balance billing is when a health care provider bills you for the difference between the providerís charge and the amount paid by UniCare (the allowed amount). For example, if the providerís charge is $100 and the allowed amount is $70, the provider may balance bill you for the remaining $30. The Plan doesnít cover balance bills, and balance bills donít count toward your out-of-pocket maximums.
By law, Massachusetts providers arenít allowed to balance bill UniCare members. However, providers in other states may do so. This means that when members use providers outside Massachusetts, they may be balance billed for these services. This may happen if the amount of the bill is more than UniCareís allowed amount for covered services.
Use a behavioral health network provider for mental health and substance use disorder services to avoid being balance billed and to get higher benefits.