I received counseling services in May 2019 and paid the full amount owed. A few months later I received a bill for these services. I have called the billing agency and the counseling service multiple times (about once a month), and each time I am told that my outstanding balance is $0.00 and that this will be reflected in my next statement, however I keep receiving bills stating that I owe money.

Today I received a letter threatening to send my alleged debt to collections if I do not pay it. I am drafting a letter to dispute the debt with the billing agency. What else can I do? Is there a consumer protection agency that can assist me with resolving this before it hits collections?


I sent a letter via certified mail stating that I did not owe anything, per my multiple conversations with the counselor's office and billing office (with dates), and requesting that they mail an updated statement reflecting this. Since I used certified mail, someone had to sign for the letter and the post office issued me a receipt showing their signature. This cost a bit extra, $6.95, but well worth it in this case.

I also spoke with the counselor's office again and they helped me escalate to a manager, who said they would put an updated statement in the mail that day. I received it a few days later and it does indicate my balance is $0.

I have saved a copy of the letter I sent, the signed receipt, the erroneous billing statements, and the corrected statement in a folder and plan to keep it indefinitely. I also have a voicemail of them confirming the $0 balance. With how disorganized their billing system is, I would not be surprised if they manage to send me to collections anyway, but I now have written proof that I don't owe the debt.

  • 44
    Them: "Your outstanding balance is $0.00000000" You: "Can you put that in an e-mail, right now?" and don't hang up until you receive the e-mail.
    – Ben Voigt
    Feb 4, 2020 at 21:35
  • 12
    @BenVoigt Tried that today. Response: "We do not send patient information via email." They are supposedly sending a letter.
    – lizziv
    Feb 4, 2020 at 21:36
  • 15
    @BenVoigt emails are nice, but They have zero mass. In court. As far as emailing them they are correct due to HIPAA. Ask for postal mail, or go pick it up at their office and bring ID. Feb 4, 2020 at 23:11
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    @Harper-ReinstateMonica they have 0 mass - except in every trial where they didn't. Given that courts have ruled that they have the same weight in real estate in 2011; I'm fairly sure you'll find they have weight in most other areas too. Just be sure to have the email; and not the printed email... because the paper versions authenticity can be disputed.
    – UKMonkey
    Feb 5, 2020 at 9:50
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    @Harper-ReinstateMonica: You're completely backwards on HIPAA -- for them to refuse to provide you with a digital copy of your records is a violation. HIPAA is primarily about portability of your information. Typically they would email you a link to a website that does further authentication to ensure it remains secure, but they cannot throw up their hands and say "secure transmission is too hard so we completely deny your right to a copy".
    – Ben Voigt
    Feb 5, 2020 at 15:25

7 Answers 7


First, collect facts.

From the collector: You need to "collect" (heh) the account number, doctor or provider's name, service date, amount, and contact information for the doctor and the collection agent. Hopefully, it's all on the letter and you won't need to contact them to chase it.

From the doctor (the one telling you that you are paid in full) you need to collect account number, service dates, amounts that are paid/settled, and their contact info.

The purpose of this exercise is to establish that we are actually talking about the same bill. Because in USA medical it's very common to get simple care for one thing, only to find this accrued 2-3 bills from different providers of various sub-services.

If the bills match up

If the bills indeed do match up, i.e. Same doctor, same account number, same dates, then contact the doctor's billing offce and ask them to state in writing that your account is paid in full. They are going to have a HIPAA problem with that. That is 100% valid, and do respect it, as it protects you. However, that still allows sending the info by postal mail, or by you picking it up at their office. Be nice, but insist on this.

Once you have this "get out of jail free" card in your hands, now you can cheese them off. Now send them (again, postal mail or hand deliver) a copy of the collector letter with a cover letter giving a good tongue lashing... tell them to call off their dog. This should invoke a huge Whoopsydaisy!" from the doctor's billing office.

Another option is to refer the collector to your insurer. You should generally keep your insurer in the loop.

If the bills do not match up

Your next step is go talk to your doctor's billing office and ask if they know anything about it. It may be what I described earlier; a separate service provider fee.

Regardless, it's time to pull your insurance company into the loop. It's possible the insurer is supposed to pay this. They can certainly advise if it's valid and what your co-pay should be. Generally if the insurer tells you to pay it, pay it.

Or haggle it

If you reach an impasse where you can't avoid paying it, push back on the provider and offer a fraction, e.g. 1/2 or 1/3. From their perspective, the longer you take to pay, the more unlikely they are to collect a dime. So 1/3 starts looking good.

Further, the US health system is positively psychotic about how they bill. For instance, one dialysis treatment (you get 3 a week) bills out at $13,800. However Medicare only pays $400, and the dialysis centers cheerfully accept that and live off that, because private insurers pay about that too, and Medicare takes over all dialysis after 3 months.

The insurers strong-arm hospitals and doctors into accepting sensible rates ("Reasonable, usual & customary", RU&C, or R&C) for services, on condition of being "in network" - and they can't afford to be in nobody's network. There aren't enough cash-flush "retail patients" around.

So the medical system insanely overcharges "retail patients" -- on the idea the uninsured indigent won't pay regardless, and this lets them get max possible dollar from insanely rich foreign medical tourists. (Who come from poor countries with awful medical systems, think Kuwait).

The upshot is that medical collectors are very accustomed to getting shockingly lowball offers, because their retail rates are shockingly highball compared to "reasonable & customary" insurance rates... And the lowball offer may still be more than they get from insurance, so still a net win.

The "Reasonable & Customary" amounts, which you'd need to research, are a good place for an offer. I'm not advocating welshing out on bona-fide medical bills from good doctors, but rather to resolve a wrong amount in collections. Some might not like that, but the rest of us have limited time and must choose our fights carefully.

I make them sign an agreement that this is a bona-fide dispute over the validity of the bill; therefore nobody will disparage anyone else, including to credit bureaus; and no amount is being forgiven, so no 1099 should be issued.

Some people have a problem paying the "collections industry". However in medical, a bill uusually spends at least a year with the original creditor (i.e the doctor) before it is sold off to third party collectors. I am advocating settling up in that time, so the doctor or lab gets some amount resembling the R&C amount they get from insurance. Keep in mind in this time you may be dealing with a collection agent, but it is still a doctor-held debt and the doctor benefits from the settlement.

  • 3
    So to sum things up... Guy1: "Most patients can't personally afford or ignore the reasonable rates we're charging." Guy2: "Let's bill them at 35x so that we can legally collect more than needed." Guy1: "Genius!" Guy2: "But wait there's more. We can also rope insurers into this so that they can profit from premiums well above anything we would charge them." Guy1: "I am so honored to be in the presence of such greatness!"
    – MonkeyZeus
    Feb 5, 2020 at 20:34
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    the US health system is positively psychotic about how they bill so many +1s for this
    – asgallant
    Feb 5, 2020 at 20:35
  • Stop calling it a "system" when it isn't one. It's a FOR-PROFIT INDUSTRY.
    – alephzero
    Feb 5, 2020 at 22:22
  • 4
    -1 for haggling. Never under any circumstances pay a single penny to a debt collector. Help annihilate their industry. Feb 6, 2020 at 17:12
  • 3
    @user560822 while that's a fine philosophy for you, the rest of us need to choose our battles. Shall someone fail in a desirable mortgage, apartment or job application because they followed your moral high ground and took a credit hit? Your situation may not have such risks but not everyone is you. DVing for that is unfair. Thqt said, yes, you are better off dealing this while the bill is still in the hands of the original service provider, not sold off to the collections industry. But medical usually gives you a yeqr to do that*. Feb 6, 2020 at 17:22

When I had this problem, I wrote the following:

We do not owe you any money. If you illegally give false information regarding this alleged debt to any credit reporting agency, we will sue you for damages as provided for in federal and state law.

I never heard from them again.

(Note, I also included some details of when it was paid, who I talked to that confirmed it, etc.)

  • 13
    +1 It might be worth it to get a lawyer to write that on the appropriate stationery and then send it to the alleged owner of the debt. The response suggested in this post will have some effect. But whatever its effect is, the effect will be multiplied by a thousand if there is a lawyer's letterhead. Feb 6, 2020 at 0:18
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    This is basically the route I've taken so far. I found a template online for disputing a medical bill, filled in my info and details about paying the bill/summary of our ongoing contact, and removed the "thank you for your prompt assistance" language (because they haven't provided that). Sent it via certified mail. I'll give it a few days to see what happens next.
    – lizziv
    Feb 6, 2020 at 16:51
  • 1
    @lizziv excellent call with sending via Certified Mail. While I know email is pretty much the default communication form these days, there is no way they can deny receiving such a letter since someone has to sign for it.
    – BruceWayne
    Feb 7, 2020 at 17:55

First, find out what their formal complaints process is, and then start it. The problem with just talking to customer services people is that they like to keep reassuring customers that everything will be fixed, without then doing anything to fix the problem. That's why you need a formal complaint to make them do something.

If you hear from any debt collection agency, tell them politely but firmly that it's a mistake, the debt is paid, and they must refer the matter back to the medical provider. You don't have to engage with them in any way beyond that. If they contact you again, tell them the same thing again.


In addition to the other answers, your rights are protected in the USA by the Fair Credit Reporting Act. See https://www.consumer.ftc.gov/articles/pdf-0096-fair-credit-reporting-act.pdf

  • 1
    +1 Simply demonstrating awareness of this law can affect a desirable attitude adjustment in debt collectors. Violations are common so it's good to get familiar with what is allowed and what is not.
    – JimmyJames
    Feb 5, 2020 at 22:24
  • 1
    Also FDCPA—if you tell them to stop contacting you, their only legal recourse is to go to court. Huge fine if they violate.
    – WGroleau
    Feb 6, 2020 at 16:40

Since the amount that they are threatening to send to collections is relatively small, this is not something to get overly worried about, especially if you have good credit otherwise.

Mostly, you will just need throw the collection company letters in a shredder and ignore their phone calls. Don't bother talking to the collectors or writing them. They don't care at all if you really owe the debt or not. They just want your money. Let your family know that if they call them about this that it is illegal harassment and your family should say so to the collector. I doubt they will put much effort into this, however. The collections representative is going to get half or less of what you owe if you pay. They won't waste a lot of time on your if you are clear that you won't pay. There are other, bigger fish.

If you can get the evidence together to show that you don't owe this, you can prepare a letters and send them to the credit bureaus. They might remove the mark from your record, or not.

It's best to get this resolved before it goes to collections but I wouldn't lose sleep over it.

  • In addition to this, know how to identify the caller, and inform anyone else who might receive calls from them, and when answering, appear baffled, tell them you have no idea who the person they're looking for is, that they have a wrong number, and not to call you again. This is the best/only way to get them to actually stop. Feb 5, 2020 at 22:20
  • @R..GitHubSTOPHELPINGICE It might help for a bit but then they resell the debt to someone else and it starts all over. I used to get calls for someone else that I guess had my number before me and I took time to do this but the calls continued. I just don't answer the phone unless I know the caller (unless the caller id say it's me.)
    – JimmyJames
    Feb 5, 2020 at 22:27
  • 1
    The best way to get a US collection agency to stop is NOT to ignore them. It is to tell them bluntly to not contact you again. They all know very well the HUGE fines they can get for violating such instructions. They rely on intimidating people who don’t know FDCPA. The only time this doesn’t work is when they are confident the debt is legitimate and very large. And then they still stop contacting you and go to court.
    – WGroleau
    Feb 6, 2020 at 16:36
  • @WGroleau Maybe they stop and then they sell the debt to someone else. It's a waste of time in my experience for small debts. By ignoring them, I don't have to talk to anyone. There are even companies fabricating debts and selling them. Assuming that these companies all follow the law is pretty naive. How many people are really going to hire a lawyer to sue someone who keeps calling them about $250?
    – JimmyJames
    Feb 6, 2020 at 17:28
  • 1
    Ignoring them means they keep calling. If they think you don’t know FDCPA, they do other illegal things, like harassing your neighbors and relatives. One firm “don’t contact me” makes most of them shift their attention to an easier victim. Especially if you mention the law that can cost them thousands. There are many lawyers who love to prosecute these cases for a share of the fine.
    – WGroleau
    Feb 6, 2020 at 17:42

I think Harper has a nice answer, but I wanted to include some important facts (at least in the U.S.): Per Experian (one of the credit reporting agencies):

  1. the three major credit bureaus (Experian, TransUnion and Equifax) now employ a 180-day waiting period before medical debt appears in your credit history. This six-month grace period is designed to give you enough time to correct any errors on your bill, pay the bill or get your insurance company to pay it, figure out a payment plan or otherwise resolve the problem.

  2. Typically, providers wait 90 days before turning your medical debt over to collections; however, some providers will wait 180 days, while others will wait just 60 days.

Experian suggests (all of which you've done):

  1. Know what to expect (e.g. copays, deductibles, etc.)
  2. Keep track of your medical bills
  3. Make sure the charges are accurate (which is hard in the US given the multiple unknown provider problem)

They also suggest (assuming you get saddled with paying a bill):

  1. Negotiating your medical bill
  2. Work out a repayment plan. (not mentioned in other answers)
  3. Keep an eye on your credit report.

The problem for them is that the chain here is

  1. They flag the debt as uncollectable in their system and sell it to a debt collector
  2. The debt collector flags it as uncollectable
  3. They report this to the credit bureaus
  4. You dispute it with the bureau

It's that last one people don't often understand

If you see an item on your credit report that you think is inaccurate, you can start a “dispute” and the credit reporting agency (such as TransUnion) will investigate the possible inaccuracy.

and if the first round fails

If you have documents to support your dispute, you can submit your request again online, with the supporting documents, and we will be happy to investigate the item(s) again. Examples of supporting documents might be a letter from the creditor or courthouse, billing statement, letter from the IRS, canceled check or money order showing payment, etc. You may also want to contact the company you hold the account with directly to make the update. Or, you can add a statement of 100 words or less to your credit file.

They are taking a risk in reporting you for a debt you paid. If you can prove you paid it (cashed check, bank statement, credit card statement) it will likely be removed.

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