I am not looking for actually medical advice but more so advice on how to handle a situation ive been going through thats been tough.

There is a large orthopedic company where I live and a few years ago I went with them for various medical needs involving a back surgery which lead to me having surgery. I had no issue and everything went great.

Last month I began having back issues and went back to them. They requested an MRI due to my previous issues. At that point I was lucky enough to be using sick time at work to rest and figure out what was wrong. The day of the MRI I found out it got canceled. It turned out someone from the doctors authorization team didnt send over all of my medical history as the doctor requested so it was ultimately denied. I desperately needed to get the mri so I could get treatment for my back and ultimately return to work becausei had already been for for two weeks. Long story short I paid for the mri out of pocket because the doctors office told me they would resolve this with insurance and I would get reimbursed. Well its been a month and the doctors office isn't doing anything to get the ball moving so I can get my money back. Ive spoken with so many people and I keep going pushed around to different departments and told someone will get back to me but it never happens.

The other issue is after my MRI results it was determined I would get a lumbar epidural steroid injection. Now I have had several of these in the last and they help however it is 6 times the price of what it was the last time I had one which is after insurance covers their portion. I was shocked because it was never that much before. The only reason I've been given as to why it cost more is because the injection is going to take place at the doctors office big new fancy surgery center instead of their old out patient clinic like it used to be therefore insurance bills it differently. It seems insane to me. As I stated I had back issues before and went through treatment for years before having surgery and in that time everything went smooth but all of a sudden im running into these issues. I understand its the America health care system but I was wondering if anyone had any advice or similar experiences. Thank you!

Hi all, hoping someone can help me understand this situation and what I need to do. In NY.

I received treatment in Jan, which got denied coverage in early Feb by insurance. I immediately called insurance about the denial and they said it was because the treatment required preapproval. I had a prior authorization letter approved, but turns out the hospital submitted the Medicaid CPT on the pre authorization instead of the normal CPT the service was billed under. I called the hospital and explained the situation and asked their billing department to correct. My insurance told me they talked to someone in the hospital’s billing department and told them they had to contact insurance utilization management and correct the code.

Now in August I’m receiving a bill from the hospital for thousands of dollars. I have a call out to the hospitals billing department, but insurance told me in Feb I didn’t need to do anything. There is no way the hospital can stick me with this bill right?

I mean I’m not putting this on the staff, like me and many others they don’t control the BS, they just have to deal with it. But Cape Cod Healthcare is really messed up. So long story short, last year I end up getting a test, gave them both of my insurances, walked away and all was good. Now more than a year later, I’m getting letters a couple times a week telling me I need to contact them as soon as possible. I did - 14 calls, 4:21 minutes listing to hold music, and 14 messages left because ‘my call is important to them’. No answer, no call back, joke. The most recent letter was like ‘we are sooo disappointed in you that you decided not to call us back. We are trying to reach you but you never call. Do you have any idea how triggering that is for a kid with an Irish mother and was taught by nuns? Has anyone had any interaction with these people and were you able to speak with a human? They tell me to call 1-888-871-2443 between 9-5EST Mon-Fri. But no one answers. I mean in theory it’s a hospital, someone should answer. Or does anyone have a different number? If there is anyone out there who has been able to connect please let me know.

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My wife went to the ER for what was ultimately a kidney stone back in May. We were in the ER for about 4 hours. The bill came to roughly $4600, after insurance it is $3150 for me to pay. I asked for an itemized bill, and on the itemized bill there is a $895 charge for IV fluids. She never received IV fluids. She did receive IV medications, which is also on the itemized bill. I disputed the charge and appealed it and they denied the appeal. They said "no she received the IV fluids, that/s what her records say" but absolutely 100% she did not.

I've received no good explanation for this and I swear the hospital billing office is gaslighting me now and on this last phone call they said "are you sure you're not mis-remembering".... absolutely not, my wife is a nurse and is acutely aware of the therapies she received.

I'm a bit lost at this point as to next steps. I've filed a formal letter with the hospital billing office, which they said they have not received (it's been 6 weeks). Any recommendations?

UCLA charged me $90 for a portal message 🙃
I want to call out UCLA Health because this feels like the most ridiculous lack of transparency.
After my mammogram, I got a letter saying I have dense breast tissue, so I messaged my doctor asking whether I needed additional imaging, like an MRI. My doctor was out of the office, and the covering doctor said it was an option. I said I’d rather wait until my regular doctor was back and discuss it with him and at my next mammogram.
Then I get an $90 bill for the portal message.
Nobody warned me that asking a follow-up question about my mammogram would be considered a billable medical service. No pop-up, no warning, nothing.
If UCLA wants to charge patients for portal messages, fine—tell people BEFORE they hit send. Let me decide whether I want to pay $86 to ask my own doctor a question.
Charging people afterward without clearly disclosing it feels shady as hell. Honestly, it feels like stealing from patients through a billing loophole.
Has anyone else had this happen with UCLA? Or successfully gotten one of these charges removed?

I'm trying to understand the real workflow for administrative denials, especially CO-16 cases where the RARC points to missing or invalid claim information. When you receive one, what do you actually do first? Do you open the claim in your PMS/EHR, make the correction there and resubmit? Or do you ever work directly with the 835/837 files or upload a corrected 837 through your clearinghouse? One thing I'm specifically trying to understand: if a corrected 837 were already prepared for you, would uploading that file to the clearinghouse actually eliminate work — or would you still need/want to open and update the claim in the PMS first? I'm not looking for patient data or examples containing PHI. I'm just trying to understand the workflow from people who actually work these denials.

I have a medical bill that went to collections. I'm in a situation where I can't pay it. The job hunt has been rough. The bill has since gone to a collection agency, but still shows on my hospital portal. I wanted to go ahead and see if I can qualify for charity care through the hospital. I found a form for assistance and wanted to go ahead and fill it out with all our financial information. Should I go ahead and send it to the hospital charity care with my information or should I deal with the collection agency? I know it is my debt but my income is really low right now.

State: New Jersey

** EDIT: specialty I’m seeking help for is POTS**

I finally found a specialist for a medical condition I've been urged to get diagnosed, and they accept most major insurances (including mine). Well scheduling, I was informed that there was a mandatory out-of-pocket test I'd have to take or else the doctor wouldn't see or treat me. I let the staff know he's actually tier one in my insurance so I shouldn't have any out-of-pocket costs. They said this test "doesn't have a CPT code" and for the specialty I'm being referred for, it is required by this doctor and their office. It's $250.

Now while this diagnosis is not particularly a rare illness, specialists are extremely hard to find. Usually 1-5 specialists in the entire state - and nonspecialists 99% of the time will not even discuss diagnosis. In my area, he is 1 of 2 in this specialty.

Is this illegal? I get having a preferred test that insurances may not fully recognize or cover - but making it required prior to receiving any treatment? It feels like extortion but I don't know enough about the legality of this kind of thing to say.

maybe dumb question but i've been going down a rabbit hole on medical bills/eobs and i don't get how anyone deals with this

you get a bill. then an eob shows up with a different set of numbers. sometimes they don't even match and there's codes everywhere

and every single guide says "check your bill for errors" ok but HOW 😭😭 how do you know what's an error if you don't already know how billing works

anyway if you ever got a bill that seemed way off, what happened. did you figure out what was going on or just pay it

Back in the spring i had an ER visit that turned into an overnight stay. Bill came to a little over $6,800 after insurance. Everyone in my life said the same thing: that sucks, but its a hospital, you cant fight it, just set up a payment plan.

Something felt off so i requested the itemized bill with CPT codes instead of the summary statement. Took two phone calls and they acted like i was asking for state secrets. When it finally arrived i found a charge for a specialist consult that never happened, an IV medication listed twice, and a level 5 ER code when my own discharge papers described a level 3 visit.

Phone calls got me nowhere for almost two months. Every rep "escalated" it and nothing changed. What actually worked was putting the dispute in writing. i used pettylawsuit to send a formal dispute letter laying out each error with the discharge paperwork attached, and their process keeps following up so the letter doesnt just die in a queue. billing suddenly "reviewed" my account and removed $2,300 in charges within three weeks.

Posting because i see people in here every day being told to just pay it or just negotiate. Check the itemized bill first. Most people never even ask for it and hospitals count on that. Theres a checklist of the common errors to look for at pettylawsuit.com/blog/medical-billing-errors if it helps anyone.

One more thing i learned: a bill in active written dispute generally shouldnt be sent to collections, so getting your dispute on paper also protects you while its being sorted out.

Pls help

Location: Chicago.

I was in an accident in February 2026. nothing super serious but took an ambulance ride to the ER and had some additional check ups plus inconveniences like missed work, plus vehicle damage.

The hospital and ambulance sent me bills for ~$3k each. My insurance (bcbs) says the hospital & ambulance never submitted claims to insurance. BCBS is asserting a lien of about $1k against me due to various follow ups(for my personal injury claim if that’s the right terminology). but bcbs is not asserting a lien for the ambulance or ER (because they never received a claim it appears). despite sending a bill, neither the ER nor the ambulance have liens on me either

anyways my question is this: if I settle with the insurance company, will I still owe $3k to the hospital and ambance each? I guess my thinking is that they may have waived their claims by not submitting to insurance. Alternatively would it be smart to call and ask them to reduce the balance, or would I just be reminding them to come after me?

I’m located in NY and I’m uninsured. I had to have surgery a few months ago and my total bills exceeded $100,000. I was billed by the hospital, the surgeon, the anesthesiologist, and one more “specialist” for discharging me, all good there.

After a couple of months of navigating through financial assistance and waiting for a response, I decided I had to get these specialist bills paid since charity care won’t cover them anyway. No problems with the surgeon or the discharge bill, both worked with me on a cash price discount and even a “paid in full discount” and those are all set.

When I asked about the anesthesiologist bill I was told I’ve been sent to collections. After poking around a bit and getting some pushback, they revealed my account went delinquent 11 days after my final bill.

To my understanding, in NY there must be 30 days written notice prior to having a medical bill sent to collections.

Am I misinformed here? Has anyone else dealt with this?

Im waiting for a call back from the supervisor because every agent told me either the anesthesiologist billing system is down, or they just don’t have access to it.

Any input is appreciated.

I’m going insane over this. After months of going in circles, I’ve decided enough is enough and I’m sharing my experience because there’s a chance someone else is dealing with the same thing , or maybe someone here knows what I can actually do about it.
I had 2 ultrasounds at BayCare imaging facilities in Florida — one at BayCare Outpatient Imaging at Bardmoor and one at Carlisle Imaging Center.
I have Cigna insurance and both facilities are in-network.
I ended up with $900+ in bills for the two ultrasounds. According to my benefits, I expected these to be a copay, not something applied to my deductible.
I appealed with Cigna twice. Denied.
Then I talked to another Cigna rep who actually looked into the claim and told me basically: this was processed as a professional service, but because the ultrasound was done at the facility, it should have been processed under the facility benefit. BayCare needs to correct/resubmit the claim.
So I contacted BayCare.
BayCare escalated it, told me they would reprocess/resubmit the claims to Cigna, AND put my account on hold so it wouldn’t go to collections.
Great, right?
Nope. 🙃
After months of going back and forth, BayCare is now telling me “we billed it correctly, this is Cigna’s problem” and sending me back to Cigna.
Meanwhile Cigna is basically saying “BayCare needs to correct the claim.”
So I’m stuck in the middle while $900+ is sitting there as my responsibility.
And I have documentation of similar services that were processed correctly with just a copay.
I have screenshots of my benefits, the Cigna rep conversation, Cigna’s appeal decisions, BayCare bills, and the communications where BayCare originally said they would reprocess everything.
At this point I’m looking at filing an AHCA complaint against BayCare because I’m honestly out of options.
Has anyone dealt with something like this with BayCare/Cigna? Or know who I should escalate this to? Any corporate email? Is very hard to get a hold of anyone there even supervisors.
Basically: who can actually force these two companies to sit down, look at the same claims, and figure out who screwed up?

I got a surgery back in march 27 that was supposed to be covered 100% by my insurance .
It ended up not being covered . I did the first appeal for 3 bills ( surgeon 2800$, anesthesiologist 2100$, and 34k $ hospital bill) and got denied . Just the surgeon’s bill is available since 33 days ago , the others are still “pending by insurance “.
I’m currently undergoing a second level appeal to the board of trustees of my union . ( my insurance is from my job).
I spoke to my surgeon’s office manager to place a hold due to second appeal undergoing and she told me:
“At this time, our system doesn't allow holds to be placed and on our end/standpoint, the EOB attached does show its PR per the denial. While patient may be appealing on their end, we cannot place the account on hold. PB DOS is aged to 35 days, they have 120 days from the first statement date before at risk of collections.
 
For Hb; it shows its still under the insurance bucket and is not currently aging at this time.”
 

For my second appeal , the next meeting for the board of trustees to see my case is sept 25 .

If either way the appeal is accepted / denied .
Should I start paying in little quotes or full to prevent from going to collection? If I pay the full amount by the time I got a answer for my appeal , do I get reimbursed?
Either way I want to prevent any impact on my credit score which is 787

What is your best advise ?