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Was this bill forgotten by a medical provider, and do notices need to be sent before collections?
Seems like the straightforward answer is to call the provider and ask.  They should be able to tell you if you owe them or not.  Unfortunately, with small providers there is always a chance they won't get even that right; I would confirm exactly why they think you don't owe them anything if in fact you don't. Medical providers can go after you for years later, depending on your state; so don't assume just because it's been months that they won't eventually.  Smaller providers aren't terribly organized, but they do usually eventually go after most of those who owe them.