A Personal Blog: Excellent Medical Care, Followed By Nasty Letters

Cindi Gatton, an Atlanta-based independent patient advocate, says hospitals, doctors and other providers have gotten a lot more ruthless in collecting medical bills. “They outsource this, and they pay the company based on collection.’’

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Final Notice,” the medical bill read.

And that cheery tone continued:

“The above account may be sent to a collection agency if we do not receive immediate payment.’’

The amount due: $26.04. At least they sent me an envelope with it (though they didn’t include a stamp).

It was the first of two such threatening bill-collecting letters I’ve received in the past few months.

I have always been a stickler for paying my bills — in full and on time. Collection agency notices and credit threats are not standard fare in our daily pile of mail. When I got this letter, I was determined to pay the money immediately.

When I went to write the check, though, it occurred to me that there was something familiar about the amount. So I checked my online bank records, and there it was: A canceled check for $26.04, written a few months earlier. To the same medical provider.

I called the phone number on the bill, and the person I talked to was somewhat taken aback by my tone. It wasn’t pleasant. They asked to see the canceled check. After I emailed a scanned version, I didn’t hear from them again.

I wondered what other people do, people with bigger medical bills and less ability to pay. What type of letters do they get?

Cindi Gatton, an Atlanta-based independent patient advocate, tells me that hospitals, doctors and other providers “have gotten a lot more ruthless in collecting these bills. They outsource this, and they pay the company based on collection.’’

“It’s very anxiety-provoking for consumers, even if it’s a small amount.’’

Then there’s the impact on a person’s credit. At least 43 million Americans have overdue medical bills on their credit reports, a federal Consumer Financial Protection Bureau report on medical debt found in 2014.

Gatton says many people have high-deductible health plans and don’t realize that their insurance doesn’t pay for everything. “People figure their insurance covers them, and they throw the bill in a drawer,’’ Gatton adds. Many haven’t hit their deductible amount, which can be thousands of dollars, so they’re on the hook whether they realize it or not.

Of course, when insurance intersects with medicine, general confusion arises. Ever try figuring out a hospital bill?

“Medical bills are more confusing. It’s the only thing you buy where you don’t know the cost of it till you bought it,’’ Gatton says.

Late last year, a friend of mine got a puzzling document in the mail from a medical provider he had used. He told me it was a long printout, full of medical terminology and lots of figures. But there was one figure highlighted in bright yellow marker, my friend said. He went to the provider and asked if the document was a bill. The staff told him it was, so he paid the highlighted sum, which was about $200.

A few days later, he received a tough-worded letter saying the bill he had just paid was late. And a few days after that, my friend received a polite letter informing him of the charge, as if the issue had not come up before. “It was like they sent the three letters in reverse order,” he told me.

Not An Easy Situation For Doctors

I actually thought my medical provider in the $26.04 case did a great job. I would use them again.

I feel the same way about the provider who sent me another bill a couple of months ago. The amount this time was $39.89.

“Your account is moving into a delinquent status due to nonpayment,’’ the letter warned.

This one I hadn’t paid.

Did I miss it in the heap of mail we get? Did we even receive a first copy?

I wouldn’t put this in the category of surprise medical bills, even though it surprised me. I wrote out a check right then and there, and carried the letter right out to the mailbox.

Bloomberg reported last year that health care providers increasingly are scrambling to get payments from people who have insurance. Doctors “have to engage in an awkward dance. One moment they’re removing a pre-cancerous skin mole. The next, they’re haranguing patients to pay what’s become a growing portion of the total medical bill.’’

“It’s harder to collect from the patient than it is from the insurance,” said Dr. Amy Derick, who heads a dermatology practice outside Chicago, Bloomberg reported. “If the plans change to a higher deductible, it’s harder to get the patients to pay.”

I understand the reimbursement pressures on hospitals and doctors, especially with the spread of high-deductible insurance. I also can sympathize with the confusion and frustration of consumers, trying to figure out what their insurance covers and what it doesn’t.

An erroneous charge, especially when the tone is hostile, can make a consumer feel like a defendant who’s being railroaded.  “When people use health care, and something like this happens, there’s total outrage,’’ Gatton says.

The funny thing is that I like the two medical providers that sent me the scary letters, and I thought they did a fine job with their service.

Not so much with this collection business.

Andy Miller is editor and CEO of Georgia Health News