Medical Balance Protection™
This is not the same as balance billing protection under the No Surprises Act.
The federal No Surprises Act protects patients from unexpected charges when they receive care from an out-of-network provider.
Medical Balance Protection™ is something different entirely.
A separate, optional insurance product offered alongside an employer's existing group health insurance and employee benefits.
Designed to pay toward the balance an employee still owes after their group health plan pays its share.
What it actually is
Medical Balance Protection™ is
one of four pillars used to build a complete benefits strategy.
Alongside group health insurance, wellness, and voluntary benefits.
It is a separate policy
Not a replacement for group health coverage.
It works alongside whatever group coverage
an employer already offers.
Here is how it works in practice.
An employee visits the doctor or is treated at a hospital.
The provider bills the insurance company.
The insurance company reprices the claim
based on the plan's negotiated rates.
Repriced claim is returned to the provider.
Showing what the plan will cover, and what remains.
The provider then bills Medical Balance Protection™
for some or all of that remaining balance.
Payment goes directly to the provider.
Not to the employee .
Why it exists
Group health insurance
covers a large share of a serious medical event.
Rarely all of it.
The maximum an employee could owe out of pocket has climbed sharply over the past decade.
The federal cap alone rose from $6,600 in 2015 to $10,600 in 2026, a 60.6 percent increase.
Real small business plans typically set individual out-of-pocket maximums between $5,500 and $7,500.
Still a significant amount for a family already managing a medical crisis.
Medical Balance Protection™ exists to close that specific gap.
The space between what group health pays, and what an employee would otherwise owe.
Why it matters
The Story of Teddy
In 1996, a man named Teddy had a heart attack.
He worked in a factory, and the only income for his household stopped the day he couldn't go back to work.
There was a delay before Social Security payments began, and by then, he had gone into foreclosure.
It came down to a choice between his medication and his mortgage.
Between paying the bank and putting food on the table for the family living with him.
A policy existed at the time that could have paid him cash to bridge that exact gap.
Nobody offered it to him.
The Story of Matt
Years later, a friend's husband ended up in the emergency room for what looked like a burst appendix.
During surgery, doctors found something else. Cancer.
He is healthy today.
But because his employer changed insurance carriers partway through the year without reviewing the plan carefully, his family hit their maximum out-of-pocket three separate times in eight months.
They were fortunate enough to absorb it through savings.
Most families living paycheck to paycheck, which is 53 percent of Americans regardless of income, would not have that option.
(LendEDU 2025 Financial Stress Survey)
Medical Balance Protection™ is optional, and employers can choose not to include it.
These are the reasons it is recommended as part of
EVERY benefits strategy built through
AgentDavidCares.com
FAQ:
Q: Is Medical Balance Protection™ the same as balance billing protection under the No Surprises Act?
A: No. The No Surprises Act is a federal law protecting patients from unexpected out-of-network charges. Medical Balance Protection™ is a separate, optional insurance product that pays toward an employee's remaining balance after group health insurance pays its share, regardless of network status.
Q: Does Medical Balance Protection™ replace group health insurance?
A: No. It is a separate policy that works alongside an employer's existing group health insurance, not a
substitute for it.
Q: Who receives the payment when a claim is filed?
A: Medical Balance Protection™ pays directly to the medical provider, not the employee. The provider is then responsible for billing any remaining balance, if any, directly.
Q: Is this available to any employer?
A: It is offered as part of a complete benefits strategy for employers who already provide group health insurance. Contact AgentDavidCares.com to see if it fits your group.
Q: Is Medical Balance Protection™ required?
A: No. It is optional, and employers can choose not to include it as part of their overall benefits strategy.
General Disclaimers/Disclosures to Satisfy the Attorneys/Legal Dept
I am a licensed Insurance Agent in any state I do business in
I am not an attorney, I do not give legal advice but I know some if you need one
I am not an accountant, I do not give tax advice but will direct you to talk to one and have some I can introduce
I am not a doctor, I do not give medical advice but I can help look up doctors in your network
I represent multiple carriers so I have more options for you
I mainly do virtual appointments, I live on top of a mountain in the middle of nowhere (about 45 minute to Crossville...you know, the BIG CITY ;)
And an hour north of Chattanooga TN
Some policies are guaranteed issue, some require underwriting
Your privacy is important to me, if you are referred to me by someone, I might tell them "Thank you for the referral" but will not use your name or discuss our conversation
Not all products are available in all states
We do not offer every plan available in your area. Currently we represent 4 organizations which offer 26 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options
Updated 07/23/2026
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