in this case
- A medical provider bills a patient directly instead of her medical sharing group, despite promises to fix the error.
- After months of ignored calls and emails requesting the correct form, the provider sends the $2,450 bill to collections.
- Can a patient fight back when a provider fails to follow billing procedures and wrongly sends them to collections?
Adrianna Gatlin is facing a $2,450 debt after Pediatrix Medical Group bills her directly for medical services. Why didn’t it send her the correct form to process her claim?
Question
After my daughter’s hospitalization, Pediatrix Medical Group sent me a bill instead of billing my medical sharing group, Medishare.
Each time I called, they promised to send a Health Care Finance Administration (HCFA) form so I could submit the claim myself, but it never arrived — even after six months of calls, emails, and letters.
Now they’ve sent the $2,450 bill to collections. I did everything I could to resolve this. Why won’t they provide the paperwork they need to get paid? — Adrianna Gatlin, Loxahatchee, Fla.
Your voice matters
Adrianna Gatlin spent six months trying to get Pediatrix to send the correct form to her medical sharing group, only to end up in collections. We want to hear your thoughts on navigating medical billing bureaucracy.
- Have you ever been wrongly billed by a medical provider or sent to collections due to their error?
- What’s the most frustrating part of dealing with medical billing departments or insurance companies?
- What are your best strategies for resolving medical billing disputes before they escalate?
Answer
Medical providers have a responsibility to bill insurers — or in your case, a medical cost-sharing group — correctly and promptly. Federal law requires providers to submit claims in a timely manner, typically within 90 to 180 days of service, depending on insurer agreements.
While Medishare isn’t traditional insurance, Pediatrix’s initial willingness to bill them suggests it acknowledged their obligation. In reviewing your correspondence with Pediatrix, it looks as if the company was having some trouble finding your membership information through Medishare. But this should have resolved this quickly. Instead, you endured months of empty promises followed by a referral to a debt collector. It should have never gone that far.
Under the Fair Debt Collection Practices Act, you have the right to dispute the debt in writing, which you did. The collections agency must cease collection efforts until they validate the debt. Pediatrix’s refusal to furnish the HCFA form likely violates its own billing policies and potentially the Health Insurance Portability and Accountability Act, which mandates that providers cooperate with patients to resolve billing disputes.
Kind of a no-brainer, but in my recent experience the insurance company bore part of the blame because they wouldn’t reach out to the provider to clarify the details of an improperly coded ER visit. The provider, for their part, was perfectly happy to keep billing me $18,000 for my alleged co-pay. I persisted, and finally the insurance co. set up a 3-way conference call with the hospital to clarify. It is months later and I still haven’t received the revised bill.
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Here’s what should have happened: Pediatrix should have either billed Medishare directly or provided the HCFA form immediately after your first request. Instead, it appears to have stonewalled you — a common tactic to pressure patients into paying out-of-pocket.
You did almost everything right. You didn’t have an extensive paper trail, which suggests you tried to resolve this by phone. Escalating to executives earlier could have helped. Pediatrix publishes the names of its executives on its website. Email addresses at Pediatrix follow the format firstname.lastname@pediatrix.com.
To keep this from happening, always confirm a provider’s status before treatment and request written confirmation of billing agreements. If it refuses to cooperate, escalate your case immediately — don’t wait for a referral to collections.
I contacted Pediatrix on your behalf. The company dismissed your debt and made arrangements to process your claim with Medishare.
Don’t get sick over bills
Your guide to navigating medical billing disputes
Before treatment: confirm coverage
After you receive a bill: act quickly
If sent to collections: know your rights
What you’re saying
Adrianna Gatlin’s billing nightmare-stuck between a provider who wouldn’t send a form and a collections agency-struck a nerve. While the top comment points to a familiar “blame loop,” many readers dug into the provider’s responsibility and the complex nature of health-sharing plans.
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It’s an adversarial system, not an error
Top commenter Ann shared her own $18,000 billing nightmare, which required a three-way call to fix. The Brown Crusader was more blunt, arguing this isn’t inefficiency but “strategy.” Sandra and Jennifer agree, noting the “burden still falls on the patient” to fix a provider’s incompetence.
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The provider “dropped the ball”
ER nurse hikergirl57 states “the provider dropped the ball” and suggests going in person to get the paperwork. AJPeabody agrees, suspecting the provider is avoiding the insurer to get a larger direct payment, calling it “all about money” and worthy of a “complaint to the state licensing board.”
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Health-sharing plans vs. single-payer
Elbee and Berkinet point out that Medi-Share is not traditional insurance, which sparked a debate. Some argued for free-market solutions, while Mr. Smith called for a “single-payer system.” BKMatthew compared his $10k U.S. surgery cost to a similar procedure in Australia that “didn’t pay a penny.”
