What will happen if I refuse to pay a medical bill?

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cutehumor
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Re: What will happen if I refuse to pay a medical bill?

Post by cutehumor » Sat Sep 30, 2017 9:59 am

My sister had the same exact problem. Doctor group on the phone said all their doctors are in network. She saw a guy twice and got billed out of network, she was hot. She called them up and the billing said "the doctor you saw was in process of being in network to your plan". She talked the billing person on the phone and they ate the bill. She said they never billed her again, it was their screw up

DaftInvestor
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Re: What will happen if I refuse to pay a medical bill?

Post by DaftInvestor » Sat Sep 30, 2017 10:01 am

I agree with others who have stated "accept insurance does not necessarily equate to "in network". If you want an in network provider you should get a list from your insurance company and pick from that list.
You should pay the bill.

staythecourse
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Re: What will happen if I refuse to pay a medical bill?

Post by staythecourse » Sat Sep 30, 2017 10:10 am

Didn't read through the rest of the responses so apologize in advance if I am repeating.

You mention that they admitted they accepted your insurance. They obviously did as they did see you and bill your insurance. The question to be answered in this cloak and dagger approach is do they admit to being IN NETWORK or just "accept your insurance". Those are 2 different things. If they admitted being IN NETWORK then just approach their practice manager for a time to drop by. Tell them you have documentation and have her/ him listen to it. That should be enough for them to drop the bill as it is obviously poor customer service at the front door. If they did NOT say they were IN NETWORK then your recording is pretty useless.

It is up to you not to pay as it seems to be a more of a moral fight on your side then a financial one. So you have to choose what to do. I can tell you the billing service will send you a final bill (usually on the third) and say if you do not pay it will be turned over to collections. The doctor office at that time will write it off as "bad debt" and off the ledger book. The collection agency at this point will go after you. If you pay or not pay at this point does not matter as it will SIGNIFICANTLY impact your credit score. If you get lucky the agency may be willing to basically erase the debt from your record if you pay in full, but that is more miss then hit.

If you don't need your credit score anytime in the next 7 years just don't pay if you don't feel like it.

Good luck.

p.s. I am sure you will not like to hear this but it is the PATIENT responsibility to confirm with the insurance company the doctor is or is not in network. For an outpatient visit that should have been pretty easy, no?
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TheTimeLord
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Re: What will happen if I refuse to pay a medical bill?

Post by TheTimeLord » Sat Sep 30, 2017 10:13 am

docbrown wrote:
Fri Sep 29, 2017 9:43 pm
I have never not paid a bill in my life. I have never been late. In fact I often pay bills early. But I have a bill I'm pretty sure I'm not going to pay, ever.

I needed to see a doctor. His office assured me that they accept my insurance. I asked them again before I saw the doctor. I also called their billing person. They all said that they accept my insurance plan.
midareff wrote:
Fri Sep 29, 2017 9:48 pm
Have you considered that they do accept your insurance, but at the out of network rate.
+1, accepting your insurance and the insurance company paying are 2 entirely different things in my mind. The question should have been to your insurance company about whether they would cover your visit, not to the doctor if he would accept your insurance. Why do you see it as the doctor's responsibility to understand what your policy will or won't reimburse or how much or your annual deductible you might have utilized to this point? Just curious did the doctor submit your claim?

As an example, my dentist accepts virtually all dental insurance and processes claims, but he does not have any agreements with any of the companies on the rates he charges so you make up the difference between what he charges and what your insurance policy covers.
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Pajamas
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Re: What will happen if I refuse to pay a medical bill?

Post by Pajamas » Sat Sep 30, 2017 10:31 am

Some Anthem companies are a complete nightmare. My health coverage is through one of their companies and it has been the most difficult organization to deal with that I have ever encountered in my entire life while my previous coverage through a different company was never a problem. I have finally gotten my complaints to a high enough level at Anthem and at the state department of insurance that they are being addressed.

Basically, their software was not processing claims properly and they refused to do anything to investigate and fix the problems it was causing until the state directed them to do so. There have been incorrect copay amounts, copays for services that don't have copays, and claims denied for the provider being out of network when they were not. Some of the problems were because of the way the provider billed, but Anthem refuses to communicate with the providers' billing services. Their provider directory included a provider who had moved to a different state several years before.

My providers do send unpaid bills to an outside collection agency but they don't report them to credit bureaus. You can ask the collection agency or billing service about that.

So here's my advice:

If their provider directory stated that the doctor was in network and the doctor's office stated that they were in network, you have grounds to file a complaint or grievance. Didn't the person who checked you in at the doctor's office look at your card, check your ID number with Anthem, accept your copay, etc.? Read your subscriber contract for how to proceed and how to appeal an initial adverse decision. Don't just accept what Anthem's software spits out or what their member services or claims people say on the phone.

Don't waste your time with multiple phone calls. Communicate in writing using their procedures, forms, addresses, etc. Expect lengthy waits for a response. There may be a deadline such as 180 days for filing a complaint, but that probably varies by state.
Last edited by Pajamas on Sat Sep 30, 2017 12:21 pm, edited 1 time in total.

Seasonal
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Re: What will happen if I refuse to pay a medical bill?

Post by Seasonal » Sat Sep 30, 2017 10:42 am

midareff wrote:
Fri Sep 29, 2017 9:48 pm
Have you considered that they do accept your insurance, but at the out of network rate.
In a rational world, "accept insurance" would mean at in-network rate, subject to co-pays and deductibles. If a doctor's office doesn't know something about insurance, they should say so, rather than blithely insisting they accept your policy and then disavowing any responsibility, especially when they always ask for your policy number, not just the carrier. It doesn't help that you can check with your insurance company, just to have them later claim their information was not necessarily up to date, so you can't rely on them either.

Alas, we don't live in a rational world.

Traveler
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Re: What will happen if I refuse to pay a medical bill?

Post by Traveler » Sat Sep 30, 2017 11:02 am

You have highlighted a major problem with our healthcare system. Healthcare is the only thing I purchase whereby I have absolutely no idea what the price is at time of service. The insurance company can't tell me and the provider can't tell me. It's a total sham and I blame both the insurers and providers. Both are in on it. However, I don't understand why you're getting into a pissing match over a $345 bill. Ask them the price of those two visits if you had no insurance and pay what they tell you. Why ruin your credit over something small just because you're trying to prove a point of some sort?

TravelforFun
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Re: What will happen if I refuse to pay a medical bill?

Post by TravelforFun » Sat Sep 30, 2017 11:08 am

ResearchMed wrote:
Fri Sep 29, 2017 10:13 pm
docbrown wrote:
Fri Sep 29, 2017 10:10 pm
midareff wrote:
Fri Sep 29, 2017 10:05 pm
How many flavors of .. as an example, Blue Cross do you think are out there? Do they all offer the same coverage?
I am familiar with the complexities of plan offerings, but billing should be able to make it clear: here's what we accept so you can tell people the right thing. Because that's a thing people tend to ask.
To repeat, one needs to ask the insurance company.
They are the ones you are expecting will pay your bill, per the terms of the contract.

This applies to "which physician" and also which procedures, or what the coverage limits are, etc.

RM
No guarantee to get a correct answer from an insurance company rep (happened to me once) and no guarantee to get a correct answer from the doctor's billing office. The forms we sign state we're responsible for payments. They don't say we're responsible for payments unless billing gives us wrong info, so I think the OP should negotiate and pay.

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celia
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Re: What will happen if I refuse to pay a medical bill?

Post by celia » Sat Sep 30, 2017 11:13 am

I was once admitted to an in-network hospital via the emergency room. The emergency room doctors are independent contractors, not hospital employees, and they don't belong to any networks. The ambulance also doesn't belong to any network. When entering the emergency room I requested in-network doctors, but they said insurance is handled when you exit so that you are given the same care regardless of your insurance. I called the insurance company after I got the Explanation of Benefits and told them I requested in-network doctors. They asked if I wanted to file an appeal. I asked how you can do that. They responded that they will fill it out for me while we are still on the phone. I told them my side of the story, they typed it up and read it all back to me, then submitted it. A week later, they paid.

From what I can tell, you haven't talked to anyone about this except us.
We can't resolve the problem for you, only guide to to what you can do. I suggest you first talk to the insurance company to understand the bill and see if you were billed correctly. (Everyone makes mistakes.) If it all sounds correct, ask why they didn't pay. If they still say "out-of-network", then ask to file an appeal since you have a strong story to support you.

Meanwhile, also call the doctor's office and ask for the billing manager. Tell them the same thing and that you were trying to follow the correct procedures. Then appeal to their sense of honoring their word. They have the ability to write this off.

I predict that both parties will act and that the bill will be zero, then the insurance company will pay!

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TheTimeLord
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Re: What will happen if I refuse to pay a medical bill?

Post by TheTimeLord » Sat Sep 30, 2017 11:15 am

celia wrote:
Sat Sep 30, 2017 11:13 am
I was once admitted to an in-network hospital via the emergency room. The emergency room doctors are independent contractors, not hospital employees, and they don't belong to any networks.
This is one of the worse gotchas in healthcare. People need to be aware that this is very common practice.
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michaeljc70
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Re: What will happen if I refuse to pay a medical bill?

Post by michaeljc70 » Sat Sep 30, 2017 11:30 am

midareff wrote:
Fri Sep 29, 2017 9:48 pm
Have you considered that they do accept your insurance, but at the out of network rate.
This. Accepting your insurance means they will take your info and bill the insurance company. It doesn't mean they are in network.

GUtiger
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Re: What will happen if I refuse to pay a medical bill?

Post by GUtiger » Sat Sep 30, 2017 11:45 am

MrJones wrote:
Sat Sep 30, 2017 1:01 am
GUtiger wrote:
Sat Sep 30, 2017 12:50 am
MrJones wrote:
Sat Sep 30, 2017 12:47 am
I ran into pretty much exactly the same problem many years ago to the tune of about $600. I too refused to pay for the principle of it. If every single person who ran into this situation refused to pay, the medical billing industry would learn their lesson pretty quickly.
Just a note here, you aren't screwing over the "medical billing industry," you're screwing over the physician.
Second, it is the physician who screwed you over by not being upfront about the specifics of billing and insurance. It is also the physician who bills people in-network far lower than people who are out-of-network or have to pay cash, for the exact same service. Here, it's the cash paying patient that is getting screwed.
The physician didn't screw anyone over here. The physician can't know which contracts he or she is a part of at all times. If you think it's as easy as "I take Blue Cross," you're wrong. There are hundreds of flavors of Blue Cross, each with a separate contract. The same physician may accept Blue Cross Providence but not Blue Cross St Mary's. I agree that the physician's office could likely have done better by the patient, but ultimately it is the onus of the patient to make sure their provider is in-network. It's not a good system, but it's the system we have.

If you're wondering why the in-network patient gets a better rate than the out-of-network it's the same idea as bulk buying. The physician accepts a lower rate from Medicare, for example, because being contracted will bring in hundreds of patients. The cash-pay patient is one person, purchasing one service. Go to a Ford dealership and see if you can get the same new car pricing as Enterprise.

Broken Man 1999
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Re: What will happen if I refuse to pay a medical bill?

Post by Broken Man 1999 » Sat Sep 30, 2017 11:56 am

Seasonal wrote:
Sat Sep 30, 2017 10:42 am
midareff wrote:
Fri Sep 29, 2017 9:48 pm
Have you considered that they do accept your insurance, but at the out of network rate.
In a rational world, "accept insurance" would mean at in-network rate, subject to co-pays and deductibles. If a doctor's office doesn't know something about insurance, they should say so, rather than blithely insisting they accept your policy and then disavowing any responsibility, especially when they always ask for your policy number, not just the carrier. It doesn't help that you can check with your insurance company, just to have them later claim their information was not necessarily up to date, so you can't rely on them either.

Alas, we don't live in a rational world.
I wouldn't want that system at all. Out of network gives the patient a wider services pool, a plus in my book.

I use a PPO which allows me to go to any doctor, but comes at a higher cost. I like that setup because should my doctor ever leave my insurance company's network, I can still use him and also enjoy some benefits of my insurance.

I have been caught one time with an out of network bill, but it was only for simple (cheap) blood tests. So I didn't have to pay much of a premium.

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2pedals
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Re: What will happen if I refuse to pay a medical bill?

Post by 2pedals » Sat Sep 30, 2017 12:17 pm

I find insurance billing and medical expenses detestable. I get bills three years after having a procedure done that has already been paid for. I get bills for improper codes submitted to the insurance company. I get bills from the doctors office saying my insurance does not cover it and find out later they did not use my correct plan id. They submit bills for thousands of dollars and in-network pays maybe hundreds. Bills are about 10x what they are really worth. So your bill should be more like $34. Sometimes it think they mess up the billing on purpose to jack up your bill.

Having said that, I think this one is on you. You should have called your insurance company first to verify if your doctor is in-network. Work out a deal with your office. IHMO you should not be asking what would happen. Get it over with and get on with your life.

numberman
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Re: What will happen if I refuse to pay a medical bill?

Post by numberman » Sat Sep 30, 2017 12:20 pm

A couple of things I don't think I've seen specifically mentioned:

If this goes to collections and you want the collectors to stop bothering you, one thing that's easy to do is to ask for verification of the debt, under the Fair Debt Collection Practices Act. This involves just sending them a letter via certified mail (the kind where you get legal proof that they received the letter), and then they are prohibited from contacting you at all until they provide written proof that you owe the money. Because the amount of owed money is low, there's less of a chance that they'll actually do that, and instead they'll just drop it once they see that collecting the money will require more work.

And of course, there are a bunch of other rules they must follow when trying to collect. If you just want to know the "rules of engagement" when dealing with such a thing, the FDCPA is probably where you want to look. A starting point: https://en.wikipedia.org/wiki/Fair_Debt ... ctices_Act . (Also note that I'm not a lawyer)


Going back to dealing with the doctor and the insurance provider: many people have suggested asking the insurance provider instead of the doctor (which makes sense), but that's no guarantee, either. If you did just ask your insurance provider, they could have told you that the doctor was in-network, and then it turns out he was out-of-network when the bill came. You'd be in pretty much the same position if that happened; if you have no proof, what could you do? The person you talked to on the phone could have just been wrong, or maybe there's a technicality that was missed (e.g. the office is in-network but not that specific doctor, or that doctor but not for that specific procedure, or that doctor but not on every 3rd wednesday).

So the question arises of how do you get someone to guarantee that something is covered before you actually do it? There is a thing called prior authorization, or pre-approval, which I believe is intended to only used for really expensive things like surgery, cancer treatment, or really expensive medication. I have no idea if an insurance provider would ever do one of those for little things, but that is the kind of document where you can point to later and say "you agreed to cover this". If you want to raise a fuss about this with the insurance provider before the next time you need something medical, you could try asking for something along those lines.

michaeljc70
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Re: What will happen if I refuse to pay a medical bill?

Post by michaeljc70 » Sat Sep 30, 2017 12:26 pm

Use the insurance companies online provider search before going to a provider. Take a screenshot of the results. Printed directories get out of date quickly. Calling the insurance company really doesn't create a good record. Asking a doctor doesn't protect you.

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dm200
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Re: What will happen if I refuse to pay a medical bill?

Post by dm200 » Sat Sep 30, 2017 12:47 pm

There are hundreds of flavors of Blue Cross, each with a separate contract. The same physician may accept Blue Cross Providence but not Blue Cross St Mary's
Yes, indeed. In this area, depending either on where you live or (for employer coverage) where you work - there are two different BCBS affiliates with different networks, rules, etc. That "line" between the two runs right through one County - so folks in the same county may have two different BCBS companies.

petiejoe
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Re: What will happen if I refuse to pay a medical bill?

Post by petiejoe » Sat Sep 30, 2017 1:05 pm

Multiple people have tried to help you understand the difference between accepting a particular insurance and being in-network. This is a very important distinction. It is not the fault of the doctor's office that you don't understand the distinction and asked the wrong question. Your comparison with accepting a particular check is flawed. The closer comparison is if you ask a grocery store "do you take credit cards" and they say "yes, we take credit cards" and then you get upset because they won't accept your EBT card. To you, maybe an EBT card is the same as a credit card at a grocery store, but you asking the wrong question in no way means that they lied to you or even misled you. You stated repeatedly that you asked if they accept your insurance and it sounds like they do indeed accept your insurance.

If you had asked what your out of pocket costs would be with a particular insurance plan, they probably would have told you they would have to call your insurance provider. Unless it's a plan they're very familiar with, it's very unlikely that they'll be able to answer the question without calling the insurance with your information (to understand where you are with your deductible, maximum coverage, or out of pocket maximums). Most offices are willing to do this for you if you ask the question. If you don't ask the question, they won't even think twice about whether you're in or out of network or how much you'll pay.

That said, you're right that the system is screwed up from top to bottom. Insurance companies have very little incentive to make it easier because they make money off of all the little exclusions and intricacies. Medical billing is very opaque - it's extremely difficult to shop around and select the cheapest price. Don't even get me started on all the different bills you receive when you go to the emergency room or have surgery.

Directly answering your question of what happens if you don't pay, I'll answer from my experience with not paying a cell phone bill (long story, but suffice it to say I didn't believe I owed the money). The doctor's office will probably sell the debt to a collections agency. The collections company won't care whether the bill is right, wrong, or otherwise - they just have a number in their database that says how much you owe. With such a small amount, it's unlikely that you'll get any of the really aggressive tactics (like calling your friends and family looking for you). If you tell them to stop calling, they might just sell your debt to another agency. Your credit rating might take a bit of a hit. It's very unlikely that you'll lose any existing lines of credit, but they may raise your interest rates a bit. It's possible that you'll pay more for insurance because of your lower credit rating - that's really hard to predict or to fully understand the actual impact. When you go to buy a house, the bank may decide that you have to settle the debt before they'll underwrite your mortgage. If you have otherwise good credit, it's unlikely this will affect your day-to-day other than the periodic calls from the latest collection agency. That doctor's office is unlikely to see you ever again, so hopefully you have other options.

WolfgangPauli
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Re: What will happen if I refuse to pay a medical bill?

Post by WolfgangPauli » Sat Sep 30, 2017 1:35 pm

$345 ??? Chalk it up to learning, pay the bill and move on....
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dm200
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Re: What will happen if I refuse to pay a medical bill?

Post by dm200 » Sat Sep 30, 2017 1:56 pm

petiejoe wrote:
Sat Sep 30, 2017 1:05 pm
Multiple people have tried to help you understand the difference between accepting a particular insurance and being in-network. This is a very important distinction. It is not the fault of the doctor's office that you don't understand the distinction and asked the wrong question. Your comparison with accepting a particular check is flawed. The closer comparison is if you ask a grocery store "do you take credit cards" and they say "yes, we take credit cards" and then you get upset because they won't accept your EBT card. To you, maybe an EBT card is the same as a credit card at a grocery store, but you asking the wrong question in no way means that they lied to you or even misled you. You stated repeatedly that you asked if they accept your insurance and it sounds like they do indeed accept your insurance.
If you had asked what your out of pocket costs would be with a particular insurance plan, they probably would have told you they would have to call your insurance provider. Unless it's a plan they're very familiar with, it's very unlikely that they'll be able to answer the question without calling the insurance with your information (to understand where you are with your deductible, maximum coverage, or out of pocket maximums). Most offices are willing to do this for you if you ask the question. If you don't ask the question, they won't even think twice about whether you're in or out of network or how much you'll pay.
That said, you're right that the system is screwed up from top to bottom. Insurance companies have very little incentive to make it easier because they make money off of all the little exclusions and intricacies. Medical billing is very opaque - it's extremely difficult to shop around and select the cheapest price. Don't even get me started on all the different bills you receive when you go to the emergency room or have surgery.
Directly answering your question of what happens if you don't pay, I'll answer from my experience with not paying a cell phone bill (long story, but suffice it to say I didn't believe I owed the money). The doctor's office will probably sell the debt to a collections agency. The collections company won't care whether the bill is right, wrong, or otherwise - they just have a number in their database that says how much you owe. With such a small amount, it's unlikely that you'll get any of the really aggressive tactics (like calling your friends and family looking for you). If you tell them to stop calling, they might just sell your debt to another agency. Your credit rating might take a bit of a hit. It's very unlikely that you'll lose any existing lines of credit, but they may raise your interest rates a bit. It's possible that you'll pay more for insurance because of your lower credit rating - that's really hard to predict or to fully understand the actual impact. When you go to buy a house, the bank may decide that you have to settle the debt before they'll underwrite your mortgage. If you have otherwise good credit, it's unlikely this will affect your day-to-day other than the periodic calls from the latest collection agency. That doctor's office is unlikely to see you ever again, so hopefully you have other options.
You make many good points.

Things like this make me very happy with our Kaiser plans over the years when we could be with Kaiser. We have never encountered receiving services fro providers that were not in our plan, nor did we ever need to receive services from outside - no matter what the service needed.

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Re: What will happen if I refuse to pay a medical bill?

Post by R2D2 » Sat Sep 30, 2017 4:16 pm

docbrown wrote:
Sat Sep 30, 2017 7:50 am
I'm probably beating a dead horse, but here's how ludicrous this is:

ON THE PHONE BEFORE THE VISIT
Them: You must pay us in one of our approved forms or we'll raise the price by a factor of 23.
You: Do you accept checks from Bank XYZ? That's all I have.
Them: Yes, we accept checks from Bank XYZ.

AFTER THE VISIT
Me: Here's my check from Bank XYZ.
Them: Why are you giving me this? This is no good here. We'll have to charge you 23 times more.
Me: But you said you accept these checks.
Them: We do accept them, but our bank, Bank ABC, does not.
Me: But you gave me reason to believe I could pay with an XYZ check.
Them: You didn't ask the question in the exact right way!
Me: Doesn't the verb "accept" have a customary and ordinary meaning in this case?
Them: Makes no difference. It's actually your responsibility to check with our bank before, during, and after the visit. You can't rely on what I tell you about our billing practices. I just work here.
Me: What do you do?
Them: I manage the billing department.
Very good analogy, OP!!

Please let us know what happens in the end. I'm surprised to see so many people defending the doctor & insurance company in this thread.

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mmmodem
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Re: What will happen if I refuse to pay a medical bill?

Post by mmmodem » Sat Sep 30, 2017 5:23 pm

I'll let others decide on what you should do. I'll just answer your question. Your credit score will go down. That's about it.

I was involved in a car accident that was their fault a few years back. I was unemployed and therefore had no way to pay the medical bills. I called the many different billing departments multiple times over 10 months explaining I will pay once I get the settlement. I had a bill from the doctor, from the hospital, from the laboratory that did tests and a few others. When I received my settlement, I paid everyone except one because they wouldn't work with me. I even pay paid late fees. The bill was sent to collections. Knowing the doctor already sold my bill to a collections agency, by paying the bill now won't go back to the doctor anyway. It was for a few hundred dollars. They wouldn't work with me, I refuse to pay a collections agency.

My credit score dipped to 740 or so. I don't know where it started at. This didn't stop me from qualifying for the best rates for cars. On homes, I got one tier below the best. Both realtors and car dealers said medical collections have little impact in qualifying for loans. They do drop my score a bit. The car dealer said I already qualified for 0% so it didn't matter. The realtor suggested I pay it off as it is a significant difference for the best rate. However, it had been 5 years since and I was concerned paying it now would reset the 7 year clock. Oddly enough my wife with half our income qualified for the home loan at the best rate without me, so we opted for that.

Most of my credit cards increased their interests rates and wrote me a letter explaining why based on the collections on my credit report. I don't carry credit card debt so this had zero effort on me. I also received collections calls but they are no more annoying than the prevalent spam calls I am still getting anyway.

So in conclusion, it had zero impact on me. After 7 years the collection dropped of my credit report.

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Re: What will happen if I refuse to pay a medical bill?

Post by OnTrack » Sat Sep 30, 2017 6:49 pm

petiejoe wrote:
Sat Sep 30, 2017 1:05 pm
Multiple people have tried to help you understand the difference between accepting a particular insurance and being in-network. This is a very important distinction. It is not the fault of the doctor's office that you don't understand the distinction and asked the wrong question.
So if I understand this correctly, as long as a doctor's office is willing to bill the patient's insurance company, then the answer to the question "Do you accept the xyz insurance plan." will always be "yes." Although that may be technically correct, a better answer would be "We will bill your insurance company, but I cannot tell you if they will pay the bill. To find that out you need to ask your insurance company." It would also be useful to state that the doctor is not an "in network" doctor if that is the case. Sometimes a yes or no answer while technically correct can leave the wrong understanding to a layperson.
Last edited by OnTrack on Sat Sep 30, 2017 6:56 pm, edited 1 time in total.

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8foot7
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Re: What will happen if I refuse to pay a medical bill?

Post by 8foot7 » Sat Sep 30, 2017 6:52 pm

People vastly overstate the impact a small medical collection item will have on a credit profile, and as some have pointed out there are various methods to disputing to use to greatly reduce the likelihood that would ever happen. If the principle is really important to you, then don't pay. Everything will be fine.

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ResearchMed
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Re: What will happen if I refuse to pay a medical bill?

Post by ResearchMed » Sat Sep 30, 2017 6:58 pm

OnTrack wrote:
Sat Sep 30, 2017 6:49 pm
petiejoe wrote:
Sat Sep 30, 2017 1:05 pm
Multiple people have tried to help you understand the difference between accepting a particular insurance and being in-network. This is a very important distinction. It is not the fault of the doctor's office that you don't understand the distinction and asked the wrong question.
So if I understand this correctly, as long as a doctor's office is willing to bill the patient's insurance company, then the answer to the question "Do you accept the xyz insurance plan." will always be "yes." Although that may be technically correct, a better answer would be "We will bill your insurance company, but I cannot tell you if they will pay the bill. To find that out you need to ask your insurance company."
Right.

That question is almost like asking, instead, "Will you cash a check if my insurance company sends one to you?"

I'm not actually sure what is meant by "Do you accept xyz insurance?"
There's *never* any guarantee that an insurer will pay any bill, or pay it in full.
In the most simple form, there is a deductible for most people, and during that stage, the insurer typically pays *nothing*.
And then there are co-pays... until some out of pocket maximum is met.
(There are, of course, some services/procedures that an insurer may pay at 100% prior to the end of both of those terms, and those probably vary dramatically among different policies.)

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Leif
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Re: What will happen if I refuse to pay a medical bill?

Post by Leif » Sat Sep 30, 2017 7:59 pm

Instead of digging in your heals I suggest to try to resolve it. I had an issue once where they said a test I had was experimental, thus not covered by insurance. The doctor said no way was it experimental. I had to go back and forth a few times and finally the hospital said they would waive it. Not exactly like your case, but if it was me I would try to get it resolved, or get the cost reduced by the Dr.'s office. Otherwise prepare for a credit hit and start looking for a new doctor.

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Re: What will happen if I refuse to pay a medical bill?

Post by 3feetpete » Sat Sep 30, 2017 8:45 pm

What will happen is that your credit will go down. The last time I got a mortgage on a house I was flagged for a long forgotten medical bill and had to pay it before the financing would proceed.

iskey
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Re: What will happen if I refuse to pay a medical bill?

Post by iskey » Sat Sep 30, 2017 9:39 pm

Docbrown, do you have an annual deductible? And was it reached prior to your visit(s)?

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Re: What will happen if I refuse to pay a medical bill?

Post by forkhorn » Sat Sep 30, 2017 10:01 pm

I have an uncle who I recently found routinely just doesn't pay medical bills that he feels are too high. He has no need for credit, and apparently none of the bills are ever high enough for him to be sued. So he just ignores the collections calls and doesn't seem to lose any sleep whatsoever. So I'm going to agree with the previous posters who say that nothing at all will happen beyond perhaps getting dropped as a patient and a meaningless ding to your credit. I can't imagine your existing credit cards will be canceled.

I have thought about adopting this tact on one or two occasions when I get outrageous bills (typically due to a surprise out-of-network event), but have not actually done it. I'm just not comfortable with the ethics (yet). It's pretty much legally cheating to me. However, increasingly I think the medical system is legally cheating us, and so, to me, the ethics are getting blurrier.

I have wondered before if some of the doctor's offices even care. If they bill $300 for a visit and don't collect, or only collect what insurance pays, I suspect they can write off the remainder. With wildly inflated "rack rates", perhaps that is fine with them.

toofache32
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Re: What will happen if I refuse to pay a medical bill?

Post by toofache32 » Sat Sep 30, 2017 10:26 pm

docbrown wrote:
Fri Sep 29, 2017 10:26 pm
I understand what you're all saying. Only the insurance company knows for sure.
Not necessarily. See below.
ResearchMed wrote:
Fri Sep 29, 2017 10:13 pm
To repeat, one needs to ask the insurance company.
You should ask BOTH. I am a doc who dropped Aetna almost a full year ago. I sent them my letter and have the certified mail receipt. They are still processing claims as in-network. They are telling patients I am still in-network. Doesn't affect me because I generally require full payment up front but it obviously confuses patients.
In addition, another doctor left my practice in 2007 to move across the country. He is still listed on some of our local insurance plans even though we have notified them more than once of his move. Remember that insurance companies benefit by making it appear they have many doctors on their plans. They have no incentive to remove doctors from their lists.
On the other hand, I have had multiple patients I was in-network with that had claims denied by their insurance stating I was out-of-network.

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Re: What will happen if I refuse to pay a medical bill?

Post by TravelGeek » Sun Oct 01, 2017 12:28 am

Jack FFR1846 wrote:
Sat Sep 30, 2017 8:36 am

That's some of what can happen. I would add that you don't ask a provider if they accept an insurance and leave it at that. You need to find someone in the insurance company who says that this specific provider (not just a facility, a specific provider) is in network. By the way, they could drop them as a provider 10 minutes after talking to you on the phone (this has happened to me).
What an incredibly inefficient system to deliver and pay for basic healthcare. If I understand the OP correctly, it was a routine visit, not a heart transplant surgery. Do doctors and insurance companies really want to get multiple calls for every single patient each time they want to make an appointment?

If the insurance company's website or the doctors office provided incorrect information, I would contact my state's insurance commissioner.

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Re: What will happen if I refuse to pay a medical bill?

Post by TravelGeek » Sun Oct 01, 2017 12:51 am

ResearchMed wrote:
Sat Sep 30, 2017 6:58 pm
I'm not actually sure what is meant by "Do you accept xyz insurance?"
After reading this thread, i am not sure anymore either. I'll have to ask my dentist and doctor's office one of these days. To quote from their websites:

"[clinic] accepts most insurance"

"We also accept most other insurance plans. Uncertain about your insurance benefits? We can help you! Give us a call today."

And yes, they all have those "disclaimers" that coverage varies and payment is ultimately the responsibility of the patient.

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Re: What will happen if I refuse to pay a medical bill?

Post by Dude2 » Sun Oct 01, 2017 4:09 am

forkhorn wrote:
Sat Sep 30, 2017 10:01 pm
I'm just not comfortable with the ethics (yet). It's pretty much legally cheating to me. However, increasingly I think the medical system is legally cheating us, and so, to me, the ethics are getting blurrier.
Clearly this is not as simple a scenario as "services are rendered, pay for services." The OP is certainly shelling out the $3xx per month (or more) for his insurance bill which is going into the gigantic pool. It isn't as if he hasn't paid out anything for services. All he wishes to happen is that the ins company directs money from the pool to his doctor. Not paying is really the only option he has to try to gain power in a system in which he has no control.
forkhorn wrote:
Sat Sep 30, 2017 10:01 pm
I have wondered before if some of the doctor's offices even care. If they bill $300 for a visit and don't collect, or only collect what insurance pays, I suspect they can write off the remainder. With wildly inflated "rack rates", perhaps that is fine with them.
Yes, this, exactly. People would love to dumb things down about this subject, but it is more complicated. The medical industry does benefit from the concept of insurance. Sometimes, it has to take a hit.

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Re: What will happen if I refuse to pay a medical bill?

Post by flyingaway » Sun Oct 01, 2017 9:31 am

As I mentioned in another thread, my wife was charged more than $700 for an ultrasound exam. She was told that the exam is free when she was checking in and asked specifically about the price. (The exam was recommended by the doctor, but not absolutely necessary). She checked online and asked friends about the price of the same exam, which would cost from $100 to $300.

After we received the bill of more than $700, my wife called the imaging facility and pointed out the problem. They first asked that if my wife would like to fill out some forms for financial assistance due to difficulty, which we refused because we are not poor. My wife told them that we would pay the market price (not the hospital price since they are not directly associated with a hospital). They said they needed to talk to their boss and have not got back to us yet.

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Re: What will happen if I refuse to pay a medical bill?

Post by DrGoogle2017 » Sun Oct 01, 2017 12:36 pm

I would negotiate with the doctor's office. They are as much to blame. And they lose just as much if the bill is going to collection. I did refuse to pay one doctor and asked him to remove the fee, I had bigger reason to sue him for less than $500 bill. He did.

On another occasion, I moved over the years and one dental bill never got to me and it was in collection, when I found out many years later, I did pay them.

My credit score has not been affected. I'm still in the high category. But not as high as my husband nor my brother.

toofache32
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Re: What will happen if I refuse to pay a medical bill?

Post by toofache32 » Sun Oct 01, 2017 12:44 pm

Fascinating how these issues are creating new market niches.
My practice is thriving in large part because none of my patients (literally zero) have these issues. They know exactly what everything costs up front and we never ask for more money later. There are never surprises. This is called being out of network. It's nowhere near as expensive as folks think.

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Re: What will happen if I refuse to pay a medical bill?

Post by Suman » Sun Oct 01, 2017 12:51 pm

As a physician, I have only one financial goal- stop taking all insurance plans. Medicare, medicaid, private insurance whatever. I became a doctor to treat patients, not to deal with this crap.

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Re: What will happen if I refuse to pay a medical bill?

Post by fsrph » Sun Oct 01, 2017 1:07 pm

Maybe I'm in the minority but I think the doctors office is at fault. When a patient calls and asks if you accept their insurance,and they respond yes, to me, that means I'm covered. If it's hard for providers to answer that question due to all the sub types of plans (Blue Cross hmo, ppo, gold, etc) just tell the patient that. Don't say yes we accept your insurance. But if they do say yes, they should be held to that answer.

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Re: What will happen if I refuse to pay a medical bill?

Post by stoptothink » Sun Oct 01, 2017 1:09 pm

Jack FFR1846 wrote:
Sat Sep 30, 2017 8:36 am
I would add that you don't ask a provider if they accept an insurance and leave it at that. You need to find someone in the insurance company who says that this specific provider (not just a facility, a specific provider) is in network. By the way, they could drop them as a provider 10 minutes after talking to you on the phone (this has happened to me).
A very similar thing happened to us a few years ago. Our regular pediatrician told us they don't accept our insurance when bringing in our daughter for her 36-month well child. Well, they had for the previous 3yrs so I immediately got on the insurance provider directory and showed the billing manager that they were on it. She still told us they didn't accept our insurance, so I called insurance and the rep told them right there that they did and that the exam would be fully covered. Went ahead and had the exam (including immunizations) and then received a bill a few months later for ~$800 from the pediatrician. Either the insurance rep was wrong or the provider was dropped in between our conversation and when the WCE (including several immunizations) was billed. Not sure, but after a few more pointless conversations with the insurance and billings reps I just paid the bill. We were looking to buy a home in the next year and I decided it just wasn't worth it to fight more. Looking back, I wish I would have stood my ground.
Last edited by stoptothink on Sun Oct 01, 2017 1:18 pm, edited 1 time in total.

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Re: What will happen if I refuse to pay a medical bill?

Post by dm200 » Sun Oct 01, 2017 1:13 pm

stoptothink wrote:
Sun Oct 01, 2017 1:09 pm
Jack FFR1846 wrote:
Sat Sep 30, 2017 8:36 am
I would add that you don't ask a provider if they accept an insurance and leave it at that. You need to find someone in the insurance company who says that this specific provider (not just a facility, a specific provider) is in network. By the way, they could drop them as a provider 10 minutes after talking to you on the phone (this has happened to me).
A very similar thing happened to us a few years ago. Our regular pediatrician told us they don't accept our insurance when bringing in our daughter for her 36-month well child. Well, they had for the previous 3yrs so I immediately got on the insurance provider directory and showed the billing manager that they were on it. She still told us they didn't accept our insurance, so I called insurance and the rep told them right there that they did and that the exam would be fully covered. Went ahead and had the exam (including immunizations) and then received a bill for ~$800 from the pediatrician. Either the insurance rep was wrong or the provider was dropped in between our conversation and when the WCE was billed. Not sure, but after a few more pointless conversations with the insurance and billings reps I just paid the bill. We were looking to buy a home in the next year and I decided it just wasn't worth it to fight more. Looking back, I wish I would have stood my ground.
Who can you believe in this whole messy situation?

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Re: What will happen if I refuse to pay a medical bill?

Post by Meaty » Sun Oct 01, 2017 4:23 pm

docbrown wrote:
Fri Sep 29, 2017 11:18 pm
Diogenes wrote:
Fri Sep 29, 2017 11:03 pm
Ask the office for their cash price and explain it to them nicely. Then pay it and move on. It's a learning experience. $345 is a pretty cheap way to learn that you don't have such a great insurance policy.
As to what will happen if you don't pay? It will be sent to collections. Pay your bills.
But that's what guys like me always do. I'm always being super responsible. I've said myself, many times in the past, $X is just cheap tuition in the long run.

You know what? It's people like us who are supporting a crooked system. If we pay for the mistakes of others, if we voluntarily pay into a flawed system because we're afraid of a silly number dropping, then we are supporting the continuation of the system as it is.

It's the craziest system. You can't get a straight answer from anyone. Nobody knows what anything costs, not even the billing staff (see above, a totally different case). I program computers for a living and I don't understand it.

I will no longer be the guy who feels responsible to cover for the flaws and mistakes of a terrible system. Let them do what they will. I set up my phone to ring only for numbers in the address book, so I'll never even be bothered about it. I will never borrow money again. I pay cash for my cars. I can afford to take a stand.
If you have a cell phone (and they know it's a cell) wait for them to call and file a TCPA claim. $1500 per violation. An attorney would likely need to help you but they'll owe you after a single call
"Discipline equals Freedom" - Jocko Willink

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Re: What will happen if I refuse to pay a medical bill?

Post by Ruger » Sun Oct 01, 2017 6:15 pm

I had this happen to me two years ago. I asked several times if they took my insurance and they told me yes.
I had an office visit and lab work, then got billed because although they took my insurance, they were not providers on my particular plan.
I should have called the insurance company to check, not the doctor's office because they can't know everything about every plan.
The bill was around $350 and I paid it. It wasn't worth screwing up my credit for a small amount, and I should have checked with the
insurance company instead of relying on the doctor's office. I wasn't happy about it, but I paid it and put it behind me...and learned from it.

richardglm
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Re: What will happen if I refuse to pay a medical bill?

Post by richardglm » Sun Oct 01, 2017 6:21 pm

Absurd that people are thinking this is OP's fault or responsibility when no one seems to have read OP's original statement that the insurance plan provider search said the provider was in-network

When both the provider and the insurance plan give inaccurate information, it is impossible for the patient to know the correct information. It cannot be the patient's responsibility to ensure the provider is in-network if there is no reliable way to do so.

If the provider was not contractually in-network at the time of service, then OP can escalate to the state insurance regulator over the insurer's refusal to pay. The insurance can pay the full balance or negotiate it down with the provider.

Maybe if the insurance plan is forced to pay enough out-of-network claims in full then they will have the incentive to keep their provider network information up to date.

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Re: What will happen if I refuse to pay a medical bill?

Post by Five Scoop » Sun Oct 01, 2017 6:44 pm

This is probably an issue where the OP has not met his deductible, as others have surmised.

OP, you have a deductible that you must meet before your insurance pays? If so, even if the doctor accepts your insurance, you might be on the hook until you meet your deductible.

My plan has a 2000 deductible. My plan explicitly states that the insurance pays 100% of cost AFTER the deductible is met. So, even if a doctor accepts my insurance, I pay everything until the deductible is met. Then the insurance starts to pay the claims.

timmy
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Re: What will happen if I refuse to pay a medical bill?

Post by timmy » Sun Oct 01, 2017 6:47 pm

Pay the bill.

jrtexas
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Re: What will happen if I refuse to pay a medical bill?

Post by jrtexas » Sun Oct 01, 2017 7:03 pm

If you're not going to need financing for anything, don't worry.

staythecourse
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Re: What will happen if I refuse to pay a medical bill?

Post by staythecourse » Sun Oct 01, 2017 7:32 pm

richardglm wrote:
Sun Oct 01, 2017 6:21 pm
Absurd that people are thinking this is OP's fault or responsibility when no one seems to have read OP's original statement that the insurance plan provider search said the provider was in-network

When both the provider and the insurance plan give inaccurate information, it is impossible for the patient to know the correct information. It cannot be the patient's responsibility to ensure the provider is in-network if there is no reliable way to do so.

If the provider was not contractually in-network at the time of service, then OP can escalate to the state insurance regulator over the insurer's refusal to pay. The insurance can pay the full balance or negotiate it down with the provider.

Maybe if the insurance plan is forced to pay enough out-of-network claims in full then they will have the incentive to keep their provider network information up to date.
My bad on my post I didn't catch that part on the OP when I gave my opinion. However, I can bet the insurer website has small print that states that all info. may not be up to date and needs to be confirmed by the specific provider.

In the end, it ALL depends if the office stated "Yes we are in network" or "Yes we accept your insurance". That difference is obviously a big one.

Good luck.
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Re: What will happen if I refuse to pay a medical bill?

Post by Artsdoctor » Sun Oct 01, 2017 8:33 pm

You're not asking the right question. The amount you're discussing is relatively insignificant. I would think that you'd want to be asking how this happened in order to decrease the likelihood of this happening again--with a much larger amount. Mistake can happen anywhere but this seems to be s systemic problem and you might want to learn a little more about steps you can take to understand where the problems occurred.

Is this an individual/family plan? If so, when did you enroll? What state are you in? What's the name of the plan as it appears on your card?

Without this information, you're going to get 100 replies that won't help you too much beyond how to deal with a collection agency. If there's anything on that card that says EPO or has a metal description (such as bronze, silver, or platinum), you might have your answer right there. However, it might not be obvious.

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Re: What will happen if I refuse to pay a medical bill?

Post by R2D2 » Sun Oct 01, 2017 8:44 pm

staythecourse wrote:
Sun Oct 01, 2017 7:32 pm
In the end, it ALL depends if the office stated "Yes we are in network" or "Yes we accept your insurance". That difference is obviously a big one.
Sorry, I've read through most of this thread and I'm honestly not sure which question I'm supposed to ask. In the past, I've checked the insurance company's web site *and* asked the doctor's office if they take my insurance *and* made sure that I was charged the in-network copay when I arrived. Is this not the correct procedure?

toofache32
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Re: What will happen if I refuse to pay a medical bill?

Post by toofache32 » Sun Oct 01, 2017 8:54 pm

R2D2 wrote:
Sun Oct 01, 2017 8:44 pm
staythecourse wrote:
Sun Oct 01, 2017 7:32 pm
In the end, it ALL depends if the office stated "Yes we are in network" or "Yes we accept your insurance". That difference is obviously a big one.
Sorry, I've read through most of this thread and I'm honestly not sure which question I'm supposed to ask. In the past, I've checked the insurance company's web site *and* asked the doctor's office if they take my insurance *and* made sure that I was charged the in-network copay when I arrived. Is this not the correct procedure?
"Taking" insurance is not the same as being in-network. In my office, I am not in-network with insurance, but I will "take" payment from either the patient or the insurance company. When it's from an insurance company, this is called assignment of benefits (AOB) and is used by both in-network and out-of-network providers. This is to distinguish out-of-network providers who require the patient to pay the full fee up front and let the patient chase after the insurance for reimbursement (no AOB needed). With assignment of benefits, the patient signs a document allowing the provider to step in the shoes of the patient and bill the insurance company directly.

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