r/MedicalBill

To start I have Medicaid. I saw a minute clinic in January to get a prescription refilled when I couldn’t get to my regular doctor. Medicaid paid for the medicine but got a bill for the visit. Called minute clinic and they said I needed to contact Medicaid. Medicaid said they would cover it and minute clinic needs to bill it to them properly. I have called them numerous times and every time I call back they said they just need to resubmit the claim because “the previous member number on file was incorrect” This has been going back and forth since then and today I got a notice that my debt was sold to collections while my claim was just resubmitted last week. I can’t afford to pay the debt. What can I do?

This is based in NV. So I recently got a text message saying I have a balance due from this dermatology office I went to back in August 2020.
I’m like wtf why am I getting this now?! I don’t want to pay it if I don’t have to. And I don’t want to get sent to collections. What are my options? I tried calling but they have an AI answering and it’s all repetitive. I ask why I’m getting it now and they said they changed their billing system.

I was scheduled for first colonoscopy as a screening colonoscopy. Confirmed it would be billed as screening otherwise was not going to do colonoscopy. It was billed as diagnostic as the facilty that performed the colonoscopy documented rectal bleeding as the reason for the colonoscopy and incidental findings of hemorrhoids.

I have had hemorroids documented for over 20 years in my medical records. The bleeding was an incidental comment I made when asking for referral to proctologist for a bothersome hemorrhoid. The bleeding was once on toilet paper after a bm hardly concerning AND not the reason for the screening referral. Has anyone had success getting them to recode to screening as the referral came from annual and states screening. And the communication when they booked the colonoscopy confirmed screening.

My colonoscopy was normal. No polyps or anything. Looked good. They noted the already known hemorrhoids. Does anyone have a similar experience? Please share.

My wife had a procedure at an in network hospital in CA in feb. 2023. From what I recall the insurance claim went through just fine, I received the EOB that said I owe around $4k. for my deductible and co-insurance. The hospital never billed me and I completely forgot about it.

Suddenly at the beginning of the week my wife gets a note in the patient portal app she has on her phone that the hospital has now billed her for the $4k through the app. We never received anything in the mail regarding this.

What can we do here? obviously I don't want to pay it, its been way too long.

I went for an MRI in May at the hospital, outpatient, and when I checked in at the front desk they ran my insurance for a ridiculously long time and produced a piece of paper with my estimated cost after insurance; it was about $450.

The lady at the front desk told me I could pay now or later, and my knee-jerk response was to pay then, but she advised me to pay later after insurance finalized everything, so I decided to pay later. She had me sign the paper with the $450 estimate that I would pay later, and then she took the paper back.

The bill hits, and it's over $2100. (About $3700 billed, insurance negotiated discount of $1600 pending.) I am pre-deductible so I'm paying 100% of whatever the insurance-negotiated "discount" prices are.

So... what the heck?? Do I have any rights here to be able to push back? Don't get me wrong, the $2k is closer to what I expected for an MRI in the first place, but why in the world did they give me an estimate that was almost five times lower than the bill they ended up slapping me with? They ran my insurance so they should have been able to see what my benefits were and that I was still under my deductible.

I have my insurance EOB, it basically just outlines what I explained 2 paragraphs above. I also called the hospital billing department, who couldn't really tell me anything other than the amount I have due and that the insurance is apparently still pending (?) (I'm not sure what to make of that either). I did request an itemized bill and he told me it will be arriving by mail in about 10 days. But other than that, I'm thinking I might try to go back to the hospital in person and ask for a copy of the estimate that I signed so I can look at it more closely, press them on it, and have evidence of how far off they were. My friend who went with me also saw the estimate, and she said they had signs posted around saying that estimates wouldn't be off by more than $350 from the actual bill. So I'm not sure if that gives me some right to contest, or if I'm exempt from that guarantee since I'm insured. This is my first year on my own insurance so it's my first rodeo. But they certainly blew the $350 discrepancy out of the water.

Again, I understand that 2k is about right for an MRI, but I think it's cruel to be giving a patient an estimate that is off by almost a factor of 5 before going in for the procedure. Based on the info they gave me, when I signed that paper, I had no idea what I was agreeing to pay. And I spent the next 6 weeks expecting to have a medical bill around $450, before getting shocked by this. Any advice on what I should be doing here?

Thanks!

My wife (57F) is in Texas, and on Medicare for the first time this year. We’re both on fixed income. She receives a weekly medical treatment for something relating to why she is on Medicare at age 57. This is about the patient fee for that treatment going from $10 to $280 per week without notice, and there being a backlog of weekly payments for the whole year now coming due.

Last year my wife had Marketplace insurance, and was in a program to help cover costs of the weekly medical treatment, making the patient cost about $10 a week. She got forced off the Marketplace coverage this year for being eligible for Medicare. The clinic providing the weekly treatment said they would submit the expenses to Medicare and “we’ll see” at the beginning of the year, and that’s the last we heard about billing until last week.

Well, their billing is messy. At this moment they are trying to print out a ledger of her expenses, but it seems it’s not all in one system. As a result, even the clinic personnel didn’t realize they were charging the Medicare rate of ~$280 per week. Apparently their accounting doesn’t recognize the fee and move it to the patient ledger until after the insurance process is done. (It seems this might be standard? I guess most places have an idea what the end charge will be and collect it into a reserve at the time of service?) We only found out because an internal process automatically looped in a billing agent once the patient ledger had more than $1000 in outstanding balance.

So, surprise! We owe them $280 a week for the year-to-date. They’ve collected $1200 so far, which they told my wife was everything she owed. She even has a receipt that tells what transactions it was applied to and that she owes no money. But, back to things not hitting the ledger until the insurance process is done and the expense is recognized, that’s just the beginning of about $5000 as a surprise bill that’s going to be trickling in for the rest of the year.

I’ve looked at surprise billing laws, and they don’t cover Medicare patients or non-hospitalization bills. The $1200 she already paid was a painful surprise, I’m not sure what we’re going to do about the following $5000.

Do I have any recourse, here? Any suggestions?

(This is a vent rather than billing related, but the part that sucks the most is this treatment was genuinely helpful. After being forced onto Medicare, which is barely cheaper than the Marketplace coverage she had, she’s going to be forced to stop this treatment over the way Medicare forces this to be billed. This is not the only treatment she’s lost access to, either. Almost all manufacturer discount programs specifically exclude Medicare patients. It’s like the government is playing “quit hitting yourself” with her medical coverage.)

In February 2023, I got a PET scan. I received an EOB but didn't save it, so I don't know what it stated.

Didn't get a bill from the provider until January 2025 (so nearly 2 years after the service). They also sent me an e-mail saying "Evicore is responsible for processing our claims for Cigna. Evicore has recently informed jour office that another provider was paid for services our offices had rendered to you and is unable to provide us with any information."

I called up Cigna, and they weren't helpful. I had switched insurance companies in 2024 and the EOB was no longer available on their website either by that point. I just forgot about it and didn't hear from the provider for months. They then sent follow-ups in June and october of last year basically repeating themselves. I ignored it since it seemed like they should go after Evicore or Cigna to get it corrected.

Fast forward to this week and I get contacted by a collections agency about the bill. They insist it's ultimately my responsibility even though the error wasn't made by me.

Any suggestions on how to contest this?

Hi everyone,
last week I discovered the clinic where I was doing some physical therapy was billed my insurance with a copay zero a cost more that one I payed at end of each session therapy and it was in agreement between the clinic and me that I signed and it was cash rate. In billing policy of the agreement there is only a cash rate and not an allowed amount.
I told my clinic of this error because my insurance was payed me more than the amount I payed to clinic because I wanted they make an adjustment for that and other that was wrong in the billing submitted. The clinic accused me to hold money that in your opinion were them. My question is correct the difference between the amount given from insurance with a copay zero( I reached my deductible so my insurance payed me the amount charged from therapy completely. This cost is different from cost in contract) and the cost in the contract was of clinic?

I just moved back to the US and am new to navigating health care. I don't know if this situation is something that I'm being sensitive about because I'm not used to it or if it's weird.

I searched up a dentist that was in network for me and booked an appointment.

Before they did any procedure, I always asked if my insurance covered it (like the X-ray, cleaning, etc) and they reassured me that it did. I told them that I'm new to insurance in the US but have learned to ask but if they can explain stuff to me that would be helpful.

He found 6 cavities. I had a check up a year ago in France and didn't have anything except tarter build up. So I asked- is this gonna cost me like 1k? He said no let me run it through your insurance and came back with an itemized quote for 800. I went forward with it and had a pleasant experience in the office. A few weeks later, I was informed I over paid by like 400$. I was happy at first but then asked how and the receptionist let it slip that they thought they weren't in network for me so the bill was higher but once they got the bill back, it was a lot lower.

Idk. That rubbed me wrong. I came there thinking that they were in network (and was right) but they never told me that even though I told them I found them through my insurance and that it is something I'm still learning in the US. I would have gone to someone who was in network if I knew that wasn't the insurance price. In the end they were wrong to bill me out of network but I still didn't like thinking that they would have never told me why the bill was so high.

Is that shady, or is that just how it is here? Like I did my part by checking if they were in network before going in, but their billing mistake made me get the vibe that even if they hadnt accidentally charged me out of network, that they would have billed my insurance weird.

An issue has arisen from a routine test my primary care doctor ordered due to my age. She ordered a routine bone density test. I called my insurance company to check on coverage and was told after being shuffled to multiple folks and a lot of phone time that a routine dexa scan was 100% covered and I would pay nothing. So I scheduled the test at an in network covered imaging center. Had the test and went home. 

Several weeks later I received a bill from the center and they say I owe them $130. 34. Really? For what? I then spent hours calling various billing departments and my doctor's office sends me the code they sent over on the order to the imaging center which shows they ordered a routine test. I was able to get the billing dept. where the test was done to do a review and find out why I was charged for a diagnostic instead of routine test. Several weeks later, I receive another bill where it states that the review found that it was a diagnostic test. I also in the meantime receive a bill from a separate Radiological Group representing the doctors who read the test who I was unaware are NOT part of the Center and I owe THEM money too! And now I see on their more specific bill, that there were two codes, one for routine AND one for diagnostic both billed to me.

I call the center again today and was informed that if the test shows a result and there is a diagnosis of any kind then the test becomes diagnostic and they bill my insurance, which won't cover it other than an adjustment and I have to pay the rest for my deductible. I had a result in a few bones of mild osteopenia (normal for women in my age group) and because I had a routine test that actually showed a result (I'm a scientist all tests show a result of some kind) I now have to pay for the test and the doctor's time and expertise.

So I had robotic hernia surgery at large academic hospital back in Nov 2024. Was never accepted by insurance despite a few appeals by hospital. Surgeon and anesthesiologist were paid within weeks of surgery. Was just this outstanding hospital services bill. After a couple appeals they made, they reduced the amount by $12,988, which also did not work. and finally about 19 months later, they are writing off rest of bill.

The new and final item line added says "Adj - unaccepted Coding Insurance W/O HIM"

Just curious/ Thoughts on what could have gone wrong for them for such a standard operation?

Hello everyone and thank you in advance!
This is in Colorado!

I was a healthy 30 year old and recently got into some medical debt after getting myocarditis after flu like symptoms.

I spent 4 days in the hospital, 8 hours in the emergency room. I was begging for a room and by the 3rd day i was begging to go home.

I recently bought into a business that cost me upwards of 100k a couple years ago. My base pay is $65,000 but can make up to $117,000 if the business does well.
But since i bought in a few years ago i just started seeing the investment pay off.

Their are a lot of details i can share but long story short i was told i don’t apply for any charity case or help because i make to much. If the bill reached %50 of my income i would get disaster relief but since i told
Them i could make up to $117k i didn’t get it…
I tried to explain my situation but they didn’t care.

I received self care which took like 10k off the bill but now im well in over $30,000 and by the end of all this ill be at over 40k… no assistance and no help for 4 days in the hospital of mostly rest with one MRI.

MRI cost me 4k alone and i found out third parties do MRIs for around $600….

Do i have any options here or should i just pay it over time?

I tried getting insurance and got scammed $800 by a fraud medical repricer.. Im seriously at Witt’s end and want to give up.

Thank you for any guidance. Sincerely.

My newborn daughter developed seizures on her second day of life while we were at WakeMed Cary Hospital (North Carolina).
The pediatric/neonatal team determined that she needed urgent NICU care with continuous EEG monitoring and further evaluation (she was later diagnosed with neonatal stroke). We did **not** choose where she would go.
According to the physician, Duke NICU was contacted first but had no available NICU beds, so my daughter was transferred to WakeMed Raleigh NICU instead. Unfortunately, the medical record does not explicitly document that Duke had no beds.
Our insurance plan is **UnitedHealthcare Choice Plus PPO**. WakeMed Raleigh is considered **out-of-network** under our plan.
We’re now seeing claims showing that most of the NICU hospitalization was processed as out-of-network, and it looks like we could be responsible for around half of the charge, and max-out-of-pocket does not apply.
I first contacted WakeMed Raleigh and asked whether No Surprise Act might apply and the claim can be treated as in-network charge, and they said I need to get a continuity-of-care first, then the claim can be processed as in-network. We did have continuity-of-care for WakeMed Cary, but that only covered the most basic CPTs.
I called UHC and asked whether the **No Surprises Act** might apply. They did not give me a direct answer but agreed to **re-review the claim** after rounds of talks. Before that, they suggested me to contact NaviGurad, which helps with the negotiations between out-of-network providers.
My questions are:
1.Does the **No Surprises Act** apply to situations like this, where parents had no choice in the transfer destination?
2.What type of documentation was most helpful? Has anyone been able to obtain a letter confirming that an in-network NICU had no available beds?
3.Is there anything else I should be doing while UHC is reviewing the claim?
Any advice or similar experiences would be greatly appreciated. Thank you!

EDIT: Attaching EOB with PII blocked out.

https://preview.redd.it/efa7ngeo7x9h1.png?width=1074&format=png&auto=webp&s=098bf98b12bad483d7fc3e79336f5bd201123e30

In the online portal the services are described as:

• Office O/p New Low 30 Min
• Visual Acuity Screen

And they correspond to the two same services on the EOB

TL;DR: Does my doctor typically see a $528 cash payment due to denial for all their new patients? Makes no sense. I'll be calling them Monday, but I want to be prepared.

____
I'm really good at fighting claims. I used to do this for a doctor, and I would often win claims to benefit both the patient and the doctor..all the time! I'm at a loss of where to begin for this one. I see paths in my mind, and I see them all getting shut down. Even though the unfairness of it seems so wrong.

My 14yo daughter is covered. Early May of 2025, she got her physical from her pediatrician. They also did a sports physical, as she was trying out in spring for a high school team. It was covered, $0 copay as it was her annual preventative visit. $328 billed, $0 copay. Services were: "Prev Visit Est Age 12-17; Collj Capillary Blood Spec; Hemoglobin; Brief Emotional/behav Assmt; Pt-focused Hlth Risk Assmt."

On the same insurance, mid-May of 2026, she needed a sports physical (the year of efficacy had passed), so she can do summer practices for her sport. In the meantime, the pediatrician died (the owner), and the practice closed / all other associates have gotten new jobs. I decided to bring her over to my own doctor and not establish her at a pediatric office anymore.

We set up an appointment, and they set is as new patient establishment; and I let them know she'll bring her blank physical form for the school system.

She had the appointment, and then they were like, let's set up her real physical for late June. I did feel they didn't do the full physical. It was more like a general conversation. No discussion of issues, just enough to fill out her form, get her vitals, weight.

Her May 2026 claim came back as denied.

Services were "Office O/p New Low 30 Min" and "Visual Acuity Screen" (which the visual screen she doesn't really need; she goes to an optometrist, and I guess this could be covered in her later real physical). Btw: the outcome of her visual screening was that she does not need glasses: 20/20 vision.

The denial was "Your plan's benefits don't cover this kind of care."

What? A preventative visit? No diagnostic codes. Why wouldn't it be covered? I will happily miss her actual, thorough physical, similar to May 2025, this week, if we can get the May 2026 "new patient visit" covered.

Amount: $528. All our responsibility. Because all I wanted was a physical for my child. *Note: I also didn't know they weren't going to do the through, actual physical. It makes sense if they want to see someone as a "new patient" first. But also, that shouldn't cost $528. And then adding the sports physical, I know some offices will charge $25-75 non-insurance-billed as a fee. What about this?

I’m struggling to figure out IPA’s in Los Angeles County. Does anyone have a resource or guide to help determine which IPA we need to submit to, specifically with a payer ID. Our office uses Optum and I do have the Optum payer lookup, but that doesn’t always give the most comprehensive answer.

I went to urgent care recently for a general physical and EKG scan. I had to pay out of pocket for it because I don't have insurance. I paid $115 dollars. This was not an emergency visit, I even told the doctor I didn't need to do the physical I just needed the EKG for my psychiatrist to start stimulants.

I've now been texted twice that I have a bill for that visit for $120. I thought it was a scam at first because I tried to log in with the account number it gave in the text and the account didnt exist. But now I'm wondering if this is actually CareNow sending me a bill.

I haven't called yet because I'm nervous about a confrontation and I want to know what's going on before I call and get blindsided by something. I just want to prepare myself to be able to advocate for myself if theyre trying to screw me over or something.

What do you think is happening? Is this a scam or does CareNow Urgent Care do this kind of thing?

I’ve been dealing with a cough, stabbing stomach pain and vomiting for over 6 months. At first, I was diagnosed with pneumonia when my main symptom was coughing, but my symptoms have continued and changed over time.

More recently, I started having significant stomach pain and have vomited with little blood. I saw another doctor who thinks this may be related to stomach issues and gave me an order for additional testing.i’m uninsured and was told I need an endoscopy, ultrasound, and x-ray. I got a chest x-ray and everything was fine. I don’t make much money and I’m worried that if I can’t afford these tests, I won’t be able to get a proper diagnosis or treatment.

I’m looking for recommendations for low-cost places maybe under 1k that can do these tests, especially self-pay pricing. I already have a doctor’s note. I’m located in Ocean County, New Jersey, but I’m willing to travel nearby if needed.

If anyone has experience with affordable imaging centers, endoscopy centers, charity care, payment plans, or places that work with uninsured patients, I’d really appreciate any suggestions.