Got charged ridiculous amount for doctor's walk in visit. What are my options?
You should start by calling the clinic and asking them to tell you how the visit was coded. Some clinics have different billing codes based on the complexity of the visit. If you have one thing you are seeing the doctor about, that could be coded differently than if you have 4 things you are seeing the doctor about. In fact, even if you are there just for one ailment, but while you are there you happen to ask a few quick questions about other possible ailments, the doctor could decide to use the billing code for the higher complexity. If when speaking to the billing department it is determined that the visit is using a higher complexity billing code (and a higher charge as a result), you could then request that it be re-coded with the lower complexity visit. Realize if you request that they will probably have to first get approval from the doctor that saw you. Note: I am basing this answer on first hand experience about 6 months ago in Illinois, where the situation I described happened to me because I asked some unrelated questions about other possible ailments at the end of a visit to an after hours clinic. The billing department explained that my visit was coded for 4 issues. (3 of them were quick questions I asked about at the end of the visit, one of which she referred me to another doctor. My additional questions probably extended the visit by 3-4 minutes.) In my case I never got the bill reduced, mainly due to my own laziness and my knowing that I would hit my deductible anyway this year. Of course I can't say for sure if this is what happened in your case, or even if this practice is widespread. This was the first and only time in my life that I encountered it. As a side note, your primary doctor would likely rarely ever bill you for a more complex visit, as it likely wouldn't lead to much repeat business. As for your last question regarding your credit: if the provider decides to lower the price, and you pay the lower price, this in no way can affect your credit. Surprising Update: When I called the billing office months ago, I had asked if they could confirm the code with the doctor, and I was told they would look into it. I never heard back, never followed up, and assumed that was the end of it. Well, today I got a call back (months later) and was informed that they had re-coded the visit which will result in a lower charge! It's still pending the insurance adjustment but at some point in the future I expect to receive either a credit on my next statement or a check in the mail. (The price difference pre-insurance in my case has gone from $359 to $235.) Update: I did receive a check for the difference. The check was dated July 20, 2016, which is just over 2 months after the phone call informing me I would receive it. Some doctors will give folks who are not covered by insurance a price break. If that describes you, you could ask. But if you didn't discuss the price in advance, that isn't the doctor's fault, any more than it would be the mechanic's fault if you asked for auto service without getting an estimate first. Consider it a cheap lesson in not making assumptions. If you are disputing the size of the charge for specific services, like you think that they overcharged for lab work, you can try disputing it with the business office staff at the doctor's office. If, on the other hand, you just think that the overall bill is too expensive then you really only have one option. You can ask if they will reduce the bill for you. Most hospitals and clinics I've dealt with have programs set up for this, but you usually access them by filling out paperwork demonstrating financial hardship (along with supporting documents). It never hurts to ask. But with the services already rendered the only person with an interest in reducing the bill is you. The reduction, if any, will probably depend on what the clinic thinks your ability to pay is compared with the cost to them of pursuing you for payment, as well as the amount of funding they have for bill reduction. When I worked in the financial services office of a hospital a $400 bill would not even have been reviewed for discounting-- the balance would be too low to devote staff time to reviewing. It's frustrating, and even asking in advance might not have given you accurate (or any!) information on what the cost of the visit would be, so your ability to shop around is limited. Unfortunately, that doesn't give you any additional options in this case. To answer the specific question of whether you can get the bill reduced without hurting your credit, yes, as long as the bill never goes to collections, there's no reason it should ever show up on your credit report. Will they reduce your bill without sending it to collections first? Maybe. All you can do is ask. You will often receive a lower bill if you simply wait for a second or third billing statement. I was once given the advice to never pay a medical bill until after they had sent three notices, because they will almost certainly reduce the amount due. Sounds crazy, right? I have excellent credit, so the idea of risking it by ignoring bills disturbed me greatly, and I scoffed at the advice.  I then had a similar experience to you, and decided to take the advice. By the third statement, the bill was reduced to less than half of the original, with zero intervention on my part. I then paid it without any impact to my credit whatsoever. I've since done that every time I receive healthcare services, and the bill is always reduced on subsequent statements, generally to less than half of the original bill. Sometimes it's because insurance finally got around to paying. Sometimes a credit is mysteriously added. Sometimes line items disappear without explanation. (Line items sometimes appear over time, too, but the overall balance generally goes down.) I don't know the reason for it, but it works. This has happened with a variety of providers, so it's not just one company that does it. Granted, I never called to negotiate the price, so I can't say if I would've gotten a better deal by doing that. I like it because it requires no time or effort on my part, and it has greatly reduced my medical bills with zero impact to my credit. I only have personal anecdotes to back it up, but it's worked for me.
Unfortunately I've seen every single example you've provided from the health care providers perspective.  Trust me, they aren't happy about the situation either - hence the reason they will demand up front payment from you based on who your insurance carrier is.  I could name a few of the top brand name insurance companies in this country that do all of this to their clients.   Medical billing is an incredibly over complicated beast.  One that insurance companies have been doing everything they can to make worse over the years.  The codes can change annually and there are MANY different codes which can cover the exact same situation.  Sure the insurance company might cover gallstones, but if you happen to be pregnant, well, that may not covered even though the treatment is the exact same. What can you do? Consider locating a new insurance company.  You do have options and don't have to go with the one your company uses.  The downside is that this is going to take quite a bit of research on your part and it will end up costing you more money on your monthly premiums simply because your company won't be footing part of the bill.   Talk to other co-workers and see if their experiences match yours.  If so, try to get a large enough group together to approach management and demand resolution.   A third potential avenue is to get politically involved - but I'm enough of a pessimist that I doubt that would do any good.  From what I've seen, neither major political party's current position actually does anything to solve the problem. A fourth option is suing the insurance company - but that is going to be incredibly expensive and take forever.  You might have better luck getting together with a bunch of local people and demand your attorney general review the billing/payment practices. Again, this is going to require a LOT of effort. A fifth option is to attempt to cash pay your bills and submit them yourself to the insurance company for reimbursement.  If you do this you can likely negotiate lower bills with the medical provider.  For anything less than about $2,000 I negotiate the amount prior to service.  Believe me when I say that providers are more than happy to give decent discounts if they know they won't have to deal with the insurance companies themselves.  Slightly more work for you, but could be far cheaper in the long run. If you read all that paperwork they made you fill out at the emergency room, there is probably something in there explicitly stating that you owe any bills you rack up regardless of what happens with the insurance company. They generally have a disclaimer that filing for you with your insurance company is a courtesy service they offer, but they are not obliged to do it.  Ultimately, you are responsible for your bills even if the provider slow-billed you.  Sorry. If they had told me that I owe them $10,000 from 3 years ago, I   wouldn't have anything to fight back. Why? First thing you have to do is ask for a proof. Have you received treatment? Have you signed the bill when you were done? This should include all the information about what you got and how much you agreed to pay. Do they have that to show to you, with your signature on it? If they don't - you owe nothing. If they do - you can match your bank/credit card/insurance records (those are kept for 7 years at least) and see what has been paid already. Can a doctor's office do that? They can do whatever they want. The right question is whether a doctor's office is allowed to do that. Check your local laws, States regulate the medical profession. Is there a statute of limitation (I'm just guessing) that forces them   to notify me in a certain time frame? Statute of limitations limits their ability to sue you successfully. They can always sue you, but if the statute of limitations has passed, the court will throw the suite away (provided you bring this defense up on time of course). Without a judgement they cannot force you to pay them, they can only ask. Nicely, as the law quoted by MrChrister mandates. They can trash your credit report and send the bill to collections though, but if the statute of limitations has passed I doubt they'd do that. Especially if its their fault. I'm not a lawyer, and you should consult with a lawyer licensed in your jurisdiction for definitive answers and legal advice. The price the provider charges you is the amount he would like to get for his services. Let's take an example, you do a blood test at a lab, and they charge you 1200.00$ If you have insurance, and the provider has a contract with that insurance (meaning 'they take them'), the contract limits what they can charge and what the will get. For the example, that might be 21.56$. This is what the insurance pays them (or what you pay them, if you have deductible). Note that if you have no insurance, you owe them 1200.00$. They are typically willing to negotiate that you only pay maybe 850.00$, but it still will be much higher than the insurance price. Why? The reason is that the insurance-agreed payment of 21.56$ does not cover their cost (but the insurance forces them to make that contract or basically be out of business). Let's say for example they need 26.56$ to make a living on it; so they lose 5.00$ on every insured customer. One in 235 customers has no insurance, and his price is calculated as 26.56+235*5.00 = ~1200.00$, so his bill covers the losses for all insured 'under-payers' (all numbers are examples made up to illustrate the math the provider does). My bloodwork typically comes between 800 and 1400, and gets reduced to around 20: so the numbers are not completely off. The ratio and concept works for doctors and hospitals the same, just not as significant a difference. Call them back and insist on speaking only with a supervisor and politely ask for their License Number and NAIC Number. When asked why reply that you are going to contact your state's insurance division and find out what recourse, if any, you might have. Merely asking for the numbers will let them know that you intend to escalate this matter; chances are that yet another supervisor will be required to rectify this situation. Companies DO NOT empower the initial representatives to resolve serious issues. It can be a tortuous path to a resolution but you must persevere. It is difficult to remove yourself and be objective but your anger will defeat you. Your agent should be on your side. I'm a business law student, so medical stuff isn't really my specialty. I'll share with you what I know though. First, as to the legality, I'm not aware of anything making it illegal for them to consider their business with you concluded. Absent any contract between you and the doctor, it seems to me that you agreed to pay them in cash. If I was the business, I'd assume our business had been concluded as well. As for any contracts between the insurance company and the doctor's office, as far as I know, that's between them. That wouldn't give you standing to sue the doctor. I'm unfamiliar with a patient submitting insurance claims, but if that's something you are allowed to do with your insurance company and all you need is more information, submit a request for your medical records to the doctor. Under United States law, your medical records are yours. You have a right to receive a copy of them. Keep in mind though that the doctor's office may charge you a small copying fee to cover expenses they incur while making a copy for you. As far as complaining, I would suggest your local Better Business Bureau. Each state generally has a medical board which oversees doctors. You might lodge a complaint with them as well. I hope this helps. Keep in mind that I'm not an attorney. This is not legal advice. This is only what I personally would do if I were in your situation. You can and should consult an attorney who is licensed to practice law in your particular jurisdiction. "What is the right way to handle this? Did you check the forms? Did the form state $0 tax due on the FTB LLC/Corp form (I'm guessing you operate as LLC/Corp, since you're dealing with the Franchise Tax)? The responsibility is ultimately yours. You should cross check all the numbers and verify that they're correct. That said, if the CPA filled the forms incorrectly based on your correct data - then she made a mistake and can be held liable. CPA filing forms from a jurisdiction on the other end of the country without proper research and knowledge may be held negligent if she made a grave mistake. You can file a law suit against the CPA (which will probably trigger her E&O insurance carrier who'll try to settle if there's a good chance for your lawsuit to not be thrown away outright), or complain to the State regulatory agency overseeing CPAs in the State of her license. Or both. Am I wrong for expecting the CPA should have properly filled out and filed my taxes? No, but it doesn't shift the responsibility from you. How can I find out if the CPA has missed anything else? Same as with doctors and lawyers - get a second opinion. Preferably from a CPA licensed in California. You and only you are responsible for your taxes. You may try to pin the penalties and interest on the CPA if she really made a mistake. California is notorious for very high LLC/Corp franchise tax (cost of registering to do business in the State). It's $800 a year. You should have read the forms and the instructions carefully, it is very prominent. It is also very well discussed all over the Internet, any search engine would pop it up for you with a simple ""California Franchise Tax for LLC/Corp"" search. CA FTB is also very aggressive in assessing and collecting the fee, and the rules of establishing nexus in CA are very broad. From your description it sounds like you were liable for the Franchise tax in CA, since you had a storage facility in CA. You may also be liable for sales taxes for that period." "I work for a health billing company. It is completely the provider's responsibility to bill your health insurance in a timely manner if they have your health insurance information on file (it sounds like they did). If you can gather a copy of your EOB (Explanation of Benefits) from your health insurance, it will likely say something to the extent of: ""claim was submitted after the timely filing limit, therefore no payment was made. The patient is not liable for the remaining balance."" Don't let the hospital/physician bully you into paying for something they should have submitted to the insurance in the first place." "You should definitely read through that contract front to back multiple times, making sure you understand every word. Voice your concern to the gym. Explain why you feel you're being cheated.   Best case: they waive the fee.   Worse case: you leave bad reviews all over social media, explaining the ""surprise fee"" practice, and *then* they waive the fee.  Very worst case: The gym refuses to waive the fee, you threaten legal action. They're probably going to waive the fee then. I don't forsee any circumstance where you actually have to take them to court.  I'd ask /r/legaladvice for sure." Ben Miller offers you sounds advice. However, if it comes down to it I would reach out to a lawyer to negotiate this for you. If what you are presenting is true then you could easily sue them for the damages incurred. I have been in a similar situation and unfortunately using the lawyers is what was required to get the solution resolved. Based on my previous experience a simple letter from a local lawyer office would get this dropped pretty quick and should cost you around $150. Best of luck! In one of your comments you say: Even if the pharmacy is not in the insurance provider network? This is why you got the check instead of your insurance company. I have Blue Cross/Blue Shield, and recently my wife underwent a procedure in the hospital, where one of the physicians involved was not in my providers network. I got a letter from the physicians office stating that since they are out of network, the standard practice was for BCBS to issue the check to me, rather than to the provider. I received the check and made the payment. The main contention is the difference in price, and that is what you need to discuss with both the pharmacy (actual billing) and your insurance company (paid benefits). The hospital likely has a contract with your insurance company which makes them obligated to bill the insurance before billing you! I had a similar occurrence that was thrown out when my insurance company provided a copy of a contract with the hospital to the judge. So if there is an agreement they must file with the insurance in timely manner. To me this is a simple cost/benefit analysis... I'm guessing you will spend a whole lot more time and effort trying to fight the collection agency than the $55 is worth. In this case I would just go ahead, pay it and be done with it. Had the amount been higher, this would change. But that's me; you should do your own analysis based on your circumstances (including how much it's worth to you to be right) and let that inform your decision. This has a straightforward answer. It's likely that your doctor and the hospital have no responsibility to ensure that your insurance claim is filed in a timely manner. They bill you whether you or they get reimbursed by insurance, or not. The insurance company is more than happy not to pay you any way they can. Sorry if this is harsh, but it's up to you to follow through. See also here. "There really isn't any good ways that I'm aware of. (The exception is in New York or California, where hospitals must post prices.) The law sets price floors on many procedures by setting Medicare and Medicaid reimbursement rates. As a result, the ""list price"" for a given procedure is dramatically inflated, and various health insurers negotiate rates somewhere in the middle. I'd recommend talking to the business offices or financial counselors at medical groups that you do business with. Ask about ""self pay discounts"" or other programs appropriate for folks in your position."