Doctor's office won't submit claim to insurance after 5 months
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.
First, as noted in the comments, you need to pay attention to your network providers.  If you are unable to pay exorbitant prices out of pocket, then find an in-network medical provider.  if you are unhappy with the in-network provider list (e.g. too distant or not specialists), then discuss switching to another plan or insurer with your employer or broker. Second, many providers will have out of pocket or uninsured price lists, often seen in outdated formats or disused binders.  Since you have asked for price lists and not been provided one, I would pursue it with the practice manager (or equivalent, or else a doctor) and ask if they have one.  It's possible that the clinic has an out of pocket price list but the front line staff is unaware of it and was never trained on it. Third, if you efforts to secure a price list fail, and you are especially committed to this specific provider, then I would consider engaging in a friendly by direct negotiation with the practice manager or other responsible person.  Person they will be amenable to creating a list of prices (if you are particularly proactive and aggressive, you could offer to find out of pocket price lists from other clinics nearby).  You could also flat out ask them to charge you a certain fee for office visits (if you do this, try to get some sort of offer or agreed price list in writing).  Most medical practices are uncomfortable asking patients for money, so that may mean flat refusal to negotiate but it may also mean surprising willingness to work with you.  This route is highly unpredictable before you go down it, and it's dependent on all sorts of things like the ownership structure, business model, and the personalities of the key people there. The easiest answer is to switch clinics.  This one sounds very unfriendly to HSA patients. Sorry to hear about your spouse's health issues. May he have a speedy and, as far as possible, full recovery. The Patient Protectection and Affordable Care Act (PPACA, aka Obamacare) is now the law of the land. Among its many provisions are that insurers may no longer deny coverage for pre-existing conditions, they may not put lifetime caps on benefits, and they may not charge different premiums based on any criteria except age cohort and geographic area (i.e. rates may be higher for 50 year olds than 30 year olds, but sick and healthy 50 year olds living in the same area pay the same). If he gets government health coverage because he's on disability, this may not matter. On the other hand, you might find it better to put him on your employer's policy, because you like the coverage better, the employer covers part of the dependent premium, or some other reason. In any case, they can't discriminate against him or you based on his condition. ETA: Rates may vary by geography as well as age. "They have forever to collect a balance from you.  Furthermore they can add whatever penalties and fees they wish to increase that balance.  Worst of all, they don't have to remind you or send you bills or any other notification.  You owed it when you left the office.  (There very well could be local laws that require notifications, but that isn't really the issue here.) That dentist has every right to deny you service until you settle the account.  Forever. The statute of limitations on collecting that debt via court: http://www.bankrate.com/finance/savings/when-does-your-debt-expire.aspx Which covers the rules on HOW LONG they have to collect the debt.  Owing the money is one thing, but the rules and tools that you creditor has to collect the debt are another.  You are probably worried about them suing you. But if you don't pay the debt (or settle in some way), that dentist can refuse to provide services to you, even if they write off the debt. Ways you can be punished by your dentist for not paying the bill are: Depending on your jurisdiction and/or type of debt, they typically only report it on your credit (if they are reporting at all) for 7 years.  Even if you pay and settle the account, it will still be reported on your credit report for 7 years.  The difference is how it is reported.  They can report that ""user133466 is a super reliable person who always pays debts on time"".  They can say ""user133466 is a flake who pays, but takes a while to pay"".  Or they can say ""user133466 is a bad person to provide services before collecting money, because user133466 don't pay bills"". Other people considering lending you money are going to read these opinions and decide accordingly if they want to deal with you or not. And they can say that for 7 years.  The idea of credit reporting is that you settle up as soon as possible and get your credit report to reflect the truth. One popular way to collect a debt to is to sue you for it.  There, each state has a different time period on how long a creditor has to sue you for a debt. http://www.bankrate.com/finance/credit-cards/state-statutes-of-limitations-for-old-debts-1.aspx If you pay part of the debt, that will often reset the clock on the statute of limitations, so be sure any partial or negotiated settlements state very clearly, in writing, that payment is considered payment in full on the debt.  Then you keep that record forever. There are other interesting points in the Fair Debt Collection Practices Act.  See Debt collectors calling? Know your rights.  They can only contact you in certain ways, they must respond to you in certain ways, and they have limits on what they can say, who they can say it to, and when they can say it.  There are protections from mean or vicious bill collectors, but that doesn't sound like who you are dealing with.  I don't know that the FDCPA is a tool you need to use in this case. You should negotiate your debt and try your best to settle up.  From your post, both parties dropped the ball, and both parties should give a little.  You should pay no or minor late fees, and the doctor should report your credit positively when you do so.  If you both made honest mistakes, they both parties should acknowledge that and be fair, and not defensive. This is not legal advice.  But you owe the debt, so you should settle up.  I don't think it is fair for you to not pay because they didn't mail you a paper.  However I also do not think it is fair for the doctor to run up fees and not remind you of the bill. Finally, you didn't bring up insurance or many other details.  Those details can change the answer." Due to the fact that months have gone by since the item was shipped to you it will be hard to resolve by sending it back.  The collection agency is now only interested in getting as much of the money as they can from you. They may have sent a percentage of the debt to the original company when they bought the debt. They may also be working on a commission. Therefore they are not interested in having everybody happy with the result. They need to follow the law, but they don't care if you are a happy customer.  The longer you wait to resolve it, the longer it will remain on the credit report. The fact that it went to collections has already hurt your score.  Yes, make sure that they update your credit file to reflect that you have paid the debt. Get it in writing. Also check with your health insurance company to see if this is at least partially covered by insurance. They generally won't cover the $12 in fees from the collections company, but they might cover part of the original bill. Depending on the item, it might also be an allowable expense for your FSA (Flexible spending account) or your HSA (Health Spending account). It is important to understand that when or before you received services from your medical provider(s), you almost certainly signed a document stating that you understand that you are fully responsible for the entire bill, even though the provider  may be willing to bill the insurer on your behalf as a service. In almost all cases, this is the arrangement, so it is very unlikely that you will be able to dispute the validity of the bill, since you did receive the service and almost certainly agreed to be fully responsible for the payments. With regard to the discounts, your medical provides have likely contracted with your insurer to provide services at a certain price or discount level, so I would base all of your negotiations with the providers and/or the collectors on those amounts. They can't legitimately bill you for the full amount since you are insured by a company they have a contract with, and you are not self-pay/uninsured, and the fact that they haven't been paid by your insurer doesn't change that, because the discount likely depends on the contact they have with your insurer and not whether or not they are billed/paid by your insurer. Please note - this is a common arrangement, but I'd recommend that you verify this with your insurer. Unfortunately, payment in 90+ days is often typical by insurance standards, so it's not yet clear to me whether or not your insurer has broken any laws such as a Prompt Pay law, or violated the terms of your policy with them (read it!). However, you need to find out which claims rep/adjuster is handling your claims and follow up with them until the payments are made. It's not personal, so make this person's life miserable until it is done and call them so often that they know it's you by the caller ID. I would also recommend contacting the collector(s), and letting them know that you don't have the money and so will not be able to pay, provide them with copies of the EOBs that state that the insurance company plans to pay the providers, and then ignore their calls/letters until the payments are made. When they call, simply reiterate that you don't have the money and that your insurance company is in the process of paying the bills. You have to expect that you will be dealing with a low-paid employee that is following a script. You are just the next person on their robo-call list, and they are not going to understand that you don't have a pile of money laying around with which to pay them, even if you tell them repeatedly. Make sure that you at no point give them access to any of your financial accounts, such as a checking or savings account, or a debit card - they will access it and clean you out. It is likely that your insurance provider will pay the providers directly since they were likely billed by the providers originally. If the providers have sold the debt to the collectors (and are not just employing a collector for debt they still own), you may have to follow up with the providers as well and make sure that the collection activity stops, since the providers may also need to forward the payments to the collectors once they are paid by the insurance company. Of course, if the insurer refuses to pay the claims, at that point I would recommend meeting with a lawyer to seek to force them to pay. 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. The insurance company issued the check.  I'd contact the insurance company to have the current check voided and a new one issued to the pharmacy. I wouldn't classify your treatment as abuse. Medical billing has become more complex not less complex. You need to learn to ask even more questions regarding expenses, you probably need to see these price quotes in writing. You did several things correctly. Staying in-network generally is best because many plans have two deductible limits: In-network, and out-of-network.  You need to make sure that the insurance company does credit you with having paid the new patient fee. That will qualify as an expense toward the deductible and your maximum out of pocket for the year. Some doctors offices don't send to insurance companies items that they know will not be covered, not remembering that these costs are critical under the High deductible plans with a health savings account. Doctors offices have problems determining how much the cost to you will be. It depends not just on the insurance company but also which type of plan you have, which sub-plan you have, and are you covered by more than one plan. Not to mention individual deductibles, family deductibles, and annual out-of-pocket amount. All this is wanted prior to the doctor seeing the patient. Most doctors offices will work with you, they know that each insurance plan treats each medical billing code differently, sometimes they make a mistake. Talk to them. Insurance is mostly for covering against catastrophic events, it's not something that must be helpful to you every day. Sounds like you health is okay and you don't mind paying some cash in case of minor events. You could try to find a policy where coverage kicks in only once an incident is big enough (high deductible) - in such cases you payments will be significantly lower because you'll be unable to apply with minor incidents and that saves money to the insurance company and you're still covered against catastrophic events. Unless it is in the contract that you must replace it then this should be replaced by your insurance. They sent you a box that was defective, consumer grade electronics are designed for at least 85 deg C (185F) and unless they can prove your car was hotter than that they sent you a defective unit.  That being said, I do not think it would be worth suing them for that low amount, I would suggest you get a new insurance company. The current company clearly values your business less than 185 pounds(?) and this issue will happen multiple times since the company has no incentive to buy better products if customers keep footing the bill. Article was about insurers not liking the uncertainty. Some insurers want Obamacare repealed, some of them want it to stay. But they all don't want to political climate of uncertainty. A situation where people wouldn't be mandated to buy insurance because they don't fear the IRS actually requiring them, but where the actual regulations haven't been changed yet is a nightmare for insurers. "The concept of emergency fund is a matter of opinion. I can tell you the consensus is that one should have 6-9 months worth of expenses kept as liquid cash. This is meant to cover literally all bills that you might encounter during that time.  That's a lot of money. There are levels of savings that are shy of this but still responsible. Not enough to cover too much in case of job loss, but enough to cover the busted transmission, the broken water heater, etc. this is still more than many people have saved up, but it's a worthy goal.  The doctor visit is probably the lowest level. Even without insurance, the clinic visit should be under $200, and this shouldn't cause you to have to carry that amount beyond the time the bill comes in.  The point that shouldn't be ignored is that if you owe money at 18% on a credit card, the emergency fund is costing you money, and is a bit misguided. I'd send every cent I could to the highest rate card and not have more than a few hundred $$ liquid until the cards were at zero.  Last - $5K, $10K in the emergency account is great, unless you are foregoing matched 401(k) dollars to do it. All just my opinion. Others here whom I respect might disagree with parts of my answer, and they'd be right.   Edit - Regarding the 'consensus 6-9 months' I suggest -  From Investopedia - ""...using the conservative recommendation to sock away eight months’   worth of living expenses...."" The article strongly support my range for the fact that it both cites consensus, yet disagrees with it.  From Money Under 30 The more difficult you rank your ability to find a new job, the more   we suggest you save — up to a year’s worth of expenses if you think   your income would be very difficult to replace. From Bank of America   I have no issue with those comfortable with less. A dual income couple who is saving 30% of their income may very well survive one person losing a job with no need to tap savings, and any 'emergency' expense can come from next month's income. That couple may just need this month's bills in their checking account." 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. It's an over crowded boat I'm sure. She hasn't had insurance all year either. She switched departments at the end of last year and they said she had to wait for open enrollment to come around again. So it wasn't by choice that she's been uninsured. It really baffles me that her company, a healthcare provider, would let their employees go through this. "Well, they can. Up to six years in many countries. There can be consequences. If you went to the dentist three years ago, were happy with the bill and returned every six months, and the dentist informs you that your six $200 bills should have each been $1,200 then it is obvious that you would have looked for another dentist if the first bill had been correct; in that case you have a very good reason to refuse to pay the difference on the other five bills.  (That's if you were not aware that the bill was wrong. If every time he fixed your teeth and the bill says ""examining your teeth"" which you would expect to be a lot cheaper, then maybe you should have known that the bill was wrong. Just an example)."