PROHIBITED: Balance Billing

Date: 04/16/24

As a reminder, Superior HealthPlan members have certain rights and protections. Among those rights is a protection against balance billing. If you are a Superior-contracted provider, balance billing is prohibited.

Balance billing occurs when a participating provider bills a member for fees and surcharges above and beyond a member’s copayment and coinsurance responsibilities for services covered under the member’s benefit program. Balance billing may also occur when a provider bills a member for an amount that is administratively denied to the provider for failure to comply with contractual obligations, and the member should not be held accountable for these costs.

If a provider has balance billed a member, the provider must take action to correct the situation. Providers are required to stop the bill collection process and work with credit reporting agencies to amend any resulting issues for the member.

For more information on balance billing, claims, additional requirements and helpful billing information, please reference the following resources:

• Balance Billing: Superior Medicaid and CHIP (PDF)
• Balance Billing: Wellcare By Allwell and STAR+PLUS MMP (PDF)
• Superior HealthPlan Provider Manuals (Ambetter from Superior HealthPlan, STAR+PLUS MMP, STAR, STAR+PLUS, CHIP, STAR Health and STAR Kids and Wellcare By Allwell) can be found on Superior's Training and Manuals webpage

For more information, or to report an inadvertent balance billing of a Superior member, please contact your local Account Manager. To access their contact information visit Find My Account Manager.