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Shifting Patterns In Balance After Insurance

Jul 30th 2014 at 12:27 AM

The US healthcare industry is facing a lot of changes due to the continual introduction of changes and reforms lately. While Providers and Healthcare Facilities work really hard towards adapting to these changes, a new problem has arisen that has direct impact on their reimbursements. The rise in Balance after Insurance (BAI) makes Healthcare Providers and Facilities struggle a lot in getting the actual reimbursements they are entitled to, despite performing medical billing and collections skillfully:

What is BAI? Balance after Insurance (BAI) is the amount that patients have to pay out of their pockets to their Healthcare Providers once the Insurance has paid its part. In the recent past, there has been an increase in BAI affecting Providers’ reimbursements badly. They have to work hard to get their patient payments while managing medical claims processing services and the the other compliance issues.


· Uninsured/Underinsured Patients: In the past, Healthcare Facilities and Providers handled insured patients with insurance plans that had lower deductibles most of the time. Therefore, the balance after insurance or BAI was considerably less. However, this situation changed after the introduction of the Affordable Care Act. Providers have started witnessing a rise in the number of patients with high BAI from the Health Exchanges and partly also due to the PPACA.

According to a healthcare survey conducted by the TransUnion on 22 hospitals in 15 states, it was found that approximately 97% of healthcare administrators reported an increase in the population of uninsured/underinsured patients since 2007. The study also found that more than 40% of Providers experienced bad debt levels between 7 and 10%. Outsourcing medical billing would make a good revenue cycle solution to this problem.

· HDHP: Recently, the healthcare domain witnessed a ten-fold increase to High Deductible Health Plans (HDHP). As a result, the out-of-pocket payments for insured patients have grown significantly. Henceforth, Providers will face an added task of following up with patients to get their payments while handling medical claims processing.

· New Payment Models: BAI is not only caused due to the increased uninsured/underinsured population or HDHP, but also due to the introduction of new payment models, including Pay-for-Performance and episode or bundled payment.


Outsourcing medical billing is one of the best revenue cycle solutions to tackle the increasing BAI. A reputed medical claim processing company can help create comprehensible pre-billing statements at ‘Point-of-service’, clearing out the confusion of ‘who pays what at the end of service’. While doing so, a medical billing company will also be able to take care of all the medical billing and collection needs diligently. Diligent Eligibility Verification could be a partial solution to this problem as well.

About MGSI:

Look no further than MGSI, if you are burdened with increasing BAI and AR pile-up due to inefficient medical claims processing. With more than 20 years of experience in the healthcare space, Tampa, FL based MGSI has been providing exceptional medical billing and collections to its clients across the nation. To learn more details, log on to

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