Determining if you have a balance bill

REDEEM™ HealthShare uses reference-based pricing (RBP) to reprice medical charges to a fair price for bills you or your provider have submitted. If you receive an updated statement in addition to the one you or your provider originally submitted to REDEEM HealthShare, it may be a balance bill.

A balance bill occurs when a provider sends you a bill requesting additional payment over the amount you owe listed in the AUA and Co-Share responsibility section in the Explanation of Sharing (EOS). If a provider is requesting the amount that matches your AUA and Co-Share responsibility of the EOS, then this is not a true balance bill.

NOTE: This only applies to bills that have already been submitted and processed.

Submit your balance bill immediately

If you receive a balance bill, please submit it immediately. Confirm you have paid the responsible amount listed in both AUA and Co-Share sections found in the EOS. If you are a member of REDEEM™ Essential, you must pay the Co-Share portion before submitting a balance bill.

See Submitting a balance bill for step-by-step instructions.

Communication about your balance bill after submission

Once you have submitted your balance bill, the member advocacy team REDEEM HealthShare partners with will review, process, and negotiate with your provider on your behalf regarding the balance bill. This team communicates updates about the balance bill with you at least every two weeks until resolved.

NOTE: Not every balance bill involves the need to negotiate.

For more help

You can find additional information in both Fair pricing commitment and Understanding and printing the details of your Explanation of Sharing.

If you have questions regarding the status of your balance bill, please call the Member Care Center, 877-641-1579, to speak with a Member Care Specialist.