Medical Billing Systems Problems and Collection Agency Fun

Beware of missing one field on a form. Also, medical billing systems are the worst.

Photo by FuYong Hua on Unsplash

I was going through my email one day when an email supposedly from a medical clinic caught my eye. It stated:

You are past due on paying us XXX dollars.

This communication is to notify you that the above referenced account with ‘Insert Clinic Name Here’ is currently past due. Failure to pay the account balance noted above in full by 12–17–2018 may result in a report to a credit bureau or use of an outside collection agency, which may negatively impact your credit score.

This was the first that I had ever heard of this bill. I recognized the name as the clinic where I got an MRI on my knee earlier in the year, but I have insurance and gave them my insurance information and expected them to handle it. Or at minimum to alert me if action was needed. Instead they were threatening actions to collect on a bill I had never seen.

Bills and collections make people nervous, so phishing and scams are common in this area. People get nervous when someone contacts them and claims to be the IRS, or a collections agency and often get their money stolen.

So first task was to make sure the bill was actually legit.

I clicked on the payment link (don’t trust links in emails!), saw what site it was sending me to, then used Google to find that same site and make sure it was actually the health provider they said they were. I found the area of the site where I could make a payment like the email had said.

Unfortunately it gets much worse. The company had recently switched billings systems and had a bit of chaos on their end. They had 2 different account number types, and a long explanation of where to find your account number on the various bills they send. With very helpful pictures. Unfortunately I had received no bill, so I couldn’t look up my account number. And to proceed, you had to know which type of account number you had.

I didn’t have an account number. I only had an email about a bill that I had never seen before.

I immediately replied to the email asking what this was about and how I could get more info. However, I had serious doubts that email was monitored and it was late so I couldn’t call them, so I got on the various social media platforms and asked them about the bill. This was hard since there was no identifying information about the bill. No patient number, no bill number, no claim number. Just the amount, and my name, which I already knew.

I went to bed and called them early the next morning.

The agent on the phone was nice, and after giving them bits of information about myself to identify that it was really me, I asked them about the bill. She fortunately was able to look it up and told me that the bill was sent to my insurance, who had given them a response that meant I had to call my insurance.

Seriously, she told me the response the insurance company gave, was ‘you need to call us’.

That didn’t make a lot of sense, but she gave me a number to use with the insurance company, as well as the dates of service and the date they requested payment from the insurance company. I thought it was going to be smoother sailing from here on out.

I also asked the nice lady on the phone, why a collections notice was the first I had ever heard about the bill.

She verified some information and told me that I had missed a field on their paperwork, so they didn’t have my address, so they couldn’t send me the bill. Which is funny because they had my email. They could have asked what my address was. Or they could have sent me the bill by email, but because they, like most companies, don’t want to spend the time or money to ensure HIPAA, compliance they don’t email bills.

But they do email you collection notices with dollar amounts! It was also funny because I had been referred to that clinic by their partner clinic where I had the initial knee examination. Their partner clinic had my info, but they probably couldn’t share it because I hadn’t signed a HIPAA info sharing agreement etc. And of course no one called me about any of these issues.

So armed with the number and dates and amount, I called the insurance company and asked about the bill, and gave them the number.

They had no idea what the number was.

The number, that the health clinic had given me. So we had to do the old, give them bits of info about myself and some dates to find what in the world we are talking about. They were able to find the bill. It was for a slightly different amount than the clinic said. They told me that, everything is normal, I have a high deductible plan, so I would pay for the MRI out of pocket because I hadn’t hit my deductible.

So a completely normal outcome. Why had they given back the response to the clinic ‘patient needs to call us’? I figured they would just have a one click ‘Patient will pay out of pocket’ button that would have saved us all some time. Maybe they did, and sent back a number that the clinic didn’t know what to do with.

So now I knew the bill was real, and I needed to pay it. I now had my account number. I thought it was going to be smooth sailing from here.

Narrators voice: It was not smooth sailing from here.

I went to the website, confidently filled out a bunch more forms and hit pay. This is what I got.

Which is funny because the clinic told me to pay online. And now their system was saying ‘This practice does not accept home payments at this time.’

So I called them back. Again.

Turns out, I had tried to pay on the last day of the month, in the middle of the day. And what do they do on the last day of the month in the middle of the day? They run their end of month report. Which takes about 3 hours and completely locks up their system. So I couldn’t pay online until that report finished.

I patiently waited 3 hours and tried again.

I waited more hours and tried again.

Finally I gave up and tried again the next day.

Success! I had successfully navigated the system and paid the bill. “Finally” I thought to myself “I am done…”

Narrators voice: He was not done

I made sure I had the receipt for my payment and then put the matter out of my mind. I had done everything they asked me to do.

Just to be sure I emailed and messaged them on social media asking ‘hey remember how you said you would send the account to collections if I didn’t pay? Well I paid. Anything else I need to do?’

There was no answer to that. But I know they saw it because read receipts.

So I was happily living my life until I got a letter, a month later from a collections agency about the bill I had already paid!

I immediately called the clinic, but it was after 5pm so they didn’t answer. I also immediately called the collection agency but they didn’t answer either.

I called them again later and got a very nice lady on the phone. We once again did the ‘give them bits of information so they can figure out what in the world is going on’ game and she found that I had paid into some system, and it hadn’t been moved to some other system, so the payment was just sitting there.

She emailed a colleague, who did something, and after a hold or two she said everything is cleared up, the payment is put in the right place and they had canceled the collection notice to the collection agency four days ago.

What?! They had already canceled the collections notice. But hadn’t told me?

So let’s recap.

Last month I got an email, about a collection agency warning, for a medical bill I had never seen, because I had missed an address field on a form, and they had my email and number and never called or emailed me about the problem, but did email me the collections warning.

But I couldn’t pay the bill because I didn’t have my account number, because it was on the bill I never got, and the response from insurance was ‘call us’, and when I called them their response was ‘normal, just pay it’, so when I tried to pay it online I couldn’t because they were running their month end report, and then I paid it.

But it got stuck in some system somewhere, so they sent my account to collections, and then figured out they messed up and canceled the collections notice but never told me, so I had to make a bunch of calls, so I wouldn’t get sent to collections…

about a bill I would have paid instantly…

if they had just emailed me.

Important Note: I am grateful I have health insurance. I am grateful I have access to competent medical professionals and the health care system works. I started this whole comedy of errors because I missed one form on one of the many very similar forms I was filling out constantly as I dealt with my knee injury. But then the system made a series of errors that could have had a negative impact on my credit and life.

If the system can make mistakes that could significantly harm individuals, the system needs some sort of accountability or error correction build in. It felt like there was none of that.

I can’t wait for new companies and systems to innovate and improve this experience. I hope one day medical care payments are as easy to do as sending a Venmo. Until then I will just have to double check forms and keep giving random people on phones random bits of information about myself.

Code, design, cook. Make stuff. Cookies. @BYU grad.