If a letter or call from Consumer Adjustment Company has you worried, you are not dealing with a scam. Consumer Adjustment Company, Inc. -- frequently shortened to "CACi" -- is a real, active third-party collection agency headquartered in St. Louis, Missouri. That said, "legit collector" and "you owe exactly what they say" are two different things, and with medical debt especially, the second is often not true.
Who Consumer Adjustment Company is
Consumer Adjustment Company is a collection agency that typically works on a contingency basis -- meaning it earns a fee only when it recovers money for a creditor. Its book of business leans heavily toward medical and healthcare accounts: hospitals, physician groups, clinics, and similar providers, plus some general consumer accounts. It is a legitimate business contacting you on behalf of someone else, not an anonymous phishing operation. Still, treat every claim about the balance as unverified until the agency puts it in writing.
"CACi" vs. "CACH, LLC" -- don't confuse them
This is the single most important thing to check. "CACi" (Consumer Adjustment Company) is easy to mix up with "CACH, LLC," which is a completely different company -- a debt buyer, covered on its own page. They are separate entities, and anything you read about one does not automatically apply to the other. Before you assume anything, confirm the exact name "Consumer Adjustment Company" and the St. Louis, Missouri address printed on your letter. If the paperwork actually says "CACH, LLC," you are dealing with the other company and should research that name instead.
If it's a medical bill, work the numbers first
Because so much of what this agency handles is healthcare debt, start by attacking the amount. Demand an itemized statement and match every line against your insurer's explanation of benefits (EOB) -- billing errors, duplicate charges, and un-applied insurance payments are common. If the bill involves an emergency or an out-of-network provider you did not choose, check the federal No Surprises Act, which can bar certain surprise balance bills. Then contact the original provider about charity care or financial assistance: nonprofit hospitals are required to offer it under IRS 501(r), and the genuinely owed number often shrinks once assistance is applied.
It's an agency, so demand validation
Since Consumer Adjustment Company collects for others rather than owning the debt, written validation should name the original creditor and show what you actually owe. Ask for it in writing within the 30-day validation window, and dispute in writing if anything looks wrong. Do not admit the debt or promise payment on a phone call -- a casual "yes" can be treated as acknowledgment. Getting the original provider identified also lets you take the medical-bill steps above directly with the source of the charge.
Your FDCPA rights and the statute of limitations
Under the Fair Debt Collection Practices Act, you can insist on written validation, dispute the balance, and tell the agency to stop calling. Check your state's statute of limitations before you act, because making a payment or a written promise to pay can restart that clock on an old account. Most important: never ignore a lawsuit. If you are served with a summons, file a written answer by the deadline -- missing it can hand the plaintiff a default judgment even if the underlying bill was wrong.
Settling if you genuinely owe it
If the debt is truly yours and correctly stated, you may be able to settle for less than the full balance on unsecured consumer debt. Negotiate in writing, get the terms in writing before you send money, and keep proof of everything. Be aware that if more than $600 of a balance is forgiven, you may receive a 1099-C, and the forgiven amount can be treated as taxable income. Go slowly, verify first, and pay only once you are confident the number is right.
This page is general information, not legal or tax advice. Your rights and timelines vary by state; consider consulting a qualified attorney, a nonprofit credit counselor, or legal aid.