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What your medical billing service says about you


After this man's wife died, he received an upsetting call about his outstanding bill.

I understand how important it is for doctors to collect all of their accounts receivable, and to bring that money in as quickly as possible. But if you also care about how your collection methods affect your patients and their families, I urge you to read this account of what happened to me, because it could be happening in your own practice, too.

My wife Mary's digestion had been getting worse for months. Since she was over 60, though, and had always had a delicate digestive system, I didn't worry too much until her abdomen became distended. Then I got really scared.

When I took Mary to her internist, "Dr. Ron," on a Friday afternoon, he was concerned as well, and scheduled a CT scan for the following Monday. But by Saturday evening she was in such discomfort that I called Dr. Ron's office. His covering physician agreed that Mary needed to go to the emergency department immediately.

They drained Mary's abdomen to make her more comfortable, and kept her overnight to make sure she was stable. Then we went home to await more definitive test results. When we saw Dr. Ron at his office the following Friday, the prognosis was grim. Mary's abdomen was distended again, and her CA-125 marker was through the roof.

Dr. Ron talked to us about treatment options, but as it turned out-mercifully-my darling Mary, the center of my life for nearly 30 years, and my constant companion for the five years since my retirement, died at home only three days later.

A devastating phone call

That was more than a year ago, and I was in pretty bad shape. One consolation, though, was the memory of how wonderfully Mary had been treated by all the physicians who had seen her at the hospital. But, less than three weeks after I'd buried her, those memories were dashed by a phone call from the billing service of one of those physicians. (In California, most hospital-based physicians bill separately for their own services.) The following, from a letter I wrote to that physician, describes what happened:

I want to alert you to an appalling experience I recently had with your billing service. When my phone rang at about 5:30 one afternoon, I answered it. There was a male voice on the line, but it was a computer calling, not a person. The voice identified itself as representing your medical group, and said it was calling about Mary's bill. It claimed there was an outstanding balance of $55.

The voice then asked if it was Mary who had answered the phone, and said to press number 1 for Yes, or 2 for No. I was understandably upset, but I wanted to know what the billing problem was, so I pressed number 1. The voice then asked me to choose from four options regarding the outstanding balance:

No other options were offered, implying that no other options were acceptable. Either pay up now, or pay up within 48 hours. How was I supposed to respond to this call? I wasn't sure which number to press.

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Jennifer N. Lee, MD, FAAFP
© National Institute for Occupational Safety and Health
© National Institute for Occupational Safety and Health
© National Institute for Occupational Safety and Health
© National Institute for Occupational Safety and Health
© National Institute for Occupational Safety and Health
© National Institute for Occupational Safety and Health