Whether it is truly balance billing will depend partially on whether the provider was in-network or out-of-network.

If the provider is in-network and billed you for more than the patient responsibility on your EOB, then this is a pretty “cut and dry” scam. Alert your insurance company and get a reference number on the call. The insurance company should have a billing specialist resolve this. In the event that you live in a state that has made “balance billing” illegal, I have letter templates for reporting in-network “balance billing” to your state’s insurance commissioner and attorney general on this book’s website at www.medicalbillsurvivalguide.com.

I have also posted the mail fraud report for the USPS mail inspection service on the website. Remember that a false “failure to pay” notice sent via the USPS is a federal mail fraud offense with criminal and civil penalties. Keep the envelope the bill came in!

If you saw an out-of-network (OON) provider, you may or may not be part of a scam. Here is how to tell:

Do you have out-of-network (OON) benefi ts?

Yes: If you do have an OON benefi t, your OON deductible and coinsurance will apply fi rst. The insurance company will pay the balance above and beyond your deductible and coinsurance just like normal. The only difference is that your OON deductible, copay, and coinsurance are probably more expensive than your in-network deductible, copay, and coinsurance.
No: If you don’t have an OON benefi t and saw this provider by accident, this is your responsibility. You need to tell them that you want to be treated like an uninsured or “self-pay” patient. They’ll apply a standard discount for a patient without insurance to your balance.

If you have an OON benefi t, did they “balance bill” you for more than your OON responsibility? If you have an OON benefi t and the provider

66 // The Medical Bill Survival Guide