I Have Insurance

Do you have insurance that should have paid an account we are trying to collect from you? Please update your insurance and at least one of the account numbers using this form so we can review your coverage and attempt to get your insurance billed.

"*" indicates required fields

Name **

Email*

Reference Number*

Insurance Name*

Insurance Phone Number*

Policy Holder

Policy Number*

Group Number

Patient Name*

Member ID*

Medical Claims Address*

File

Drop files here or

Accepted file types: pdf, doc, docx, Max. file size: 15 MB.

Please check the box to acknowledge:*

I agree, in order for Balanced Healthcare Receivables LLC to service your account or to collect any amounts you may owe now or in the future, we may contact you by telephone at any telephone number associated with your account, including wireless telephone numbers, which could result in charges to you. We may also contact you by sending text messages, SMS or e-mails, using any e-mail address that you provide to us. Methods of contact may include using pre-recorded/artificial voice messages and/or use of an automatic dialing device (ATDS), as applicable. If you have any questions or would like to talk to a live Collections Specialist, please call 1-866-460-2471 during standard business hours: Monday thru Thursday 8am – 8pm, Friday 8am – 6:30pm, Saturday 8am – 12:00pm Eastern Standard Time.

Are you human?

This communication is from a debt collector. This is an attempt to collect a debt and any information obtained will be used for that purpose.