Why Chat I am just curious what would be the next step if doctor refuses to sign for the letter with check enclosed when I send it signature required? Since it is a very small office and they know exactly who I am what if they don't sign for the letter. Should I then try sending it by express mail and don't put my name and address on it?

If you address it to the HIPAA Compliance Officer and they refuse to sign, you will have a very good reason to file suit against them for a myriad of violations. You need to send it CMRR and you need to have your name and address clearly shown as it MAY be legal for them to refuse to sign for "unknown" sender mail.

What stage are you in the program?? Have you opted out and sent the medical dispute letter??