Final answer:
The section of a managed care participation contract that covers balance-billing rules is typically found in the reimbursement or provider payment section. Balance-billing refers to the practice of a healthcare provider billing a patient for the difference between the provider's charge and what the insurance company covers. Managed care contracts include balance-billing rules to regulate and protect patients from excessive charges.
Step-by-step explanation:
The section of a managed care participation contract that covers balance-billing rules is typically found in the section related to reimbursement or provider payment.
Balance-billing refers to the practice of a healthcare provider billing a patient for the difference between the provider's charge and what the insurance company covers. This can happen when the provider is not part of the insurance company's network, or when the insurance company does not fully cover a particular service. Balance-billing rules are included in managed care contracts to regulate and protect patients from excessive charges.
For example, in a managed care contract, there might be a clause that states that providers must accept the insurance company's payment as full payment and cannot bill the patient for the difference. This helps prevent surprise bills and ensures that patients are not responsible for excessive out-of-pocket costs.