First I'll need some info as there are a couple of different ways to get this taken care of and they would produce positive results.Florida has balance billing laws but Federal rules apply to group health plans.1) Is your wife's plan a group health plan under an employer that is not church or govt/state?It’s a private employer. We are in South Carolina but her company is headquartered in Florida. 2) Was this ER, Primary care, Urgent care?It was Conway medical center in Conway, South Carolina. 3) Was the actual hospital/facility billed processed and paid at in network? You said the physician was paid, this was radiology provider billing?The doctor visit was billed and processed as in-network. So was an x-ray that she ordered. So then she ordered the MRI and it was processed as “in-network” on the claim, but they only paid the out of network amount towards it. For some weird reason. But everything was done in the same building, and the only issue we are having is with the MRI which is fishy because it is obviously the most expensive thing. I really think her insurance company is trying to rip her off, so I have no idea how to make them do the right thing. A lawyer would be pointless because it would cost just as much. I can give more guidance on the type of appeal/complaint you might have with the above info