Bait and switch billing. I told the person at the desk that I don't have insurance and would need to pay private-pay for services and needed to know the cost up front. Was informed that my family of 4 with 65k total income doesn't qualify for the sliding scale, and that the cost for this visit would total $180. I winced and said wow, that's a lot of money for me, but I have to do it for my kid to go to school. The desk person seemed to commiserate, but did not offer any options. When I saw the doctor, she wanted to break up the vaccines into two visits: I told her 180 was a lot of money and asked her if I would have to pay another 180 for a follow up visit. She said they could fit them all in on the same visit to save me money. About ten days later I got this bill for about $1k.

I get it, medicine is expensive. However, professional, direct, up front and honest communication is free: all you have to do is care. Access Blue Island doesn't.