The Unfathomable World of The Billing Office

When I started working as an advocate, I was under the assumption that billing offices existed to assist with answering questions on bills, arrange possible payment plans and/or negotiate. I learned by trial and error the process  is not as simple or straight forward.  It can be as difficult and frustrating as any other part of the healthcare system.

On every healthcare bill is the sentence, if you need assistance call customer service, with a number nearby.  When you call the number, the front line folks are the customer representatives.  These people work under whatever guidelines set forth by their institution.  They are trained to stay well within these guidelines.  For example, there is a set amount, a percentage, for any discount related to self pay.  They cannot at any time offer more.  Only a supervisor can authorize an increased amount if appropriate.

Here is what I have learned from my many conversations with business offices over the years.  Although, all customer representatives are trained under the same guidelines, it is not unusual to receive different answers to the same question.  Answers so different, it becomes unclear how to proceed.  I recently was trying to set up a payment plan for client.  In three days, I got three different amounts and time line all with an ultimatum about not risking collections.  What was annoying for me was my conversation with each person was in the computer and ignored.  I finally spoke the “S” word…..SUPERVISOR!

Now the fun begins.  It is not unusual to be told the supervisor is either speaking with someone else, not available and would you like to leave a voicemail.  Leaving a message is the billing office black hole.  It is the rare supervisor who calls back in a timely matter.  When I leave a message, I hope to get a call within four days.  If I don’t, I start calling daily.  I sometimes wonder if there is  a billing training manual that under supervisor role says,

  • a. ignore calls for as many days as possible
  • b. the calls may go away,
  • c. if call back or mistakenly answer the person’s call say “I have been so busy.”

It is a mystery to me because I have begun to think, billing offices would rather send bills to collections than actually work anything out.  Yesterday, a  customer representative said to me, she couldn’t set up a long term payment plan because the computer doesn’t allow for any plans past four months starting from the date of service. ( initial bills are not sent out until a month after the day of service.)

I asked her if there was any way to adjust the computer.  Answer was, no and proceeded to tell me that my client could make small payments monthly to them but it would still go to collections.  I asked her what that meant.  She answered, the collection agency would try to collect the entire debt and be calling her regularly.  I asked even though she was making monthly payments?  The answer was yes.  I thought for a moment, I must be in Monty Python skit or being punked!

I suppose in the business world it makes sense that the offices sell their debt after a certain period of time but it is counter intuitive if someone is making payments.  I also know a supervisor can adjust a program to reflect what has been agreed upon.

I am also discovering a growing unwillingness to allow for extended payment plans.  Many plans options  are now three months and after much back and forth maybe six months.  Imagine you have a bill for $10,000 and you are told you have to pay it in three to six months.  Since you may have some resources whether in savings, a CD or IRA, you are expected to pay.  For any extended payment plan, the option for some institutions is  a contracted loan business and added interest.  And just like a credit card, if you are late or miss a payment, the interest increases dramatically and you are charged a late fee.

I want to clarify, not all offices are like this but it is becoming more common place.  Nor do I think institutions should shoulder the rising cost of healthcare and the uninsured.   Demanding payment in a very small  time window, expecting people to use retirement funds for payment and a quick rush to collections is not the answer.