My daughter works for United with United Health Insurance at a United owned doctor's office with a lab onsite. Nobody said a thing about her lab work until she got a bill for $80 because the doctor office apparently decided to send the lab work out of network.
My wife went in for a well check, before they created a similar form above. Her doctor asked her a question about her health progress and took notes. The billing office deemed that conversation outside the scope of a well visit and tried to charge $100 or so, for conversation the doctor started.
My son went for his yearly before leaving for college. I get a bill for $500. They put his visit on my health record. We have the same name but it hasn't been a problem for 18 years. They charged a 3 year old insurance policy, despite having charged the correct insurance for the two years prior and taking his current insurance card prior to the visit.
And, that is just the events since June at three different offices.