Where we left off in Part 3, Steve had received a billing statement with collections language.
This was an undisputedly pivotal moment. After months of research, paperwork review, screen time, rejected requests, narrow responses, and total silence, the collections notice marked the turning point we had hoped for.
Attempting collections while an account is in dispute is generally frowned upon in most industries. When it occurs, it completely rebalances the risk profile of the case for the business. Large institutions don’t settle because the customer was right, well-researched, sophisticated, or persistent, they settle when the risk of prolonging the matter begins outweighing the cost of a clean exit.
On the business side, I understand that billing departments and frontline staff handle a massive volume of inquiries. What happened to Steve was not personal: automation was probably set up, and the word never made it across departments to pause it. I’m not faulting them for that.
However, Steve’s rights had to be preserved. Given that the situation was tense and premature escalation could push the matter into an arena Steve was not comfortable with, the best course was to notify the relevant departments directly. To avoid the issue getting stuck in a silo, we sent letters to Patient Relations, Billing, and Revenue Integrity.
Then we waited.
The final step of the process immediately following the PRAR’s expiration is the Administrative Reveiw request, a last-ditch effort to secure a resolution within the confines of their internal process.
However, the collections notice changed the calculus for the pending administrative review in both content and timing.
For Steve, it meant an extended reprieve. Our notice of the “collections activity” landed just days before the PRAR timeline expired. Sending the admin review request at that exact moment could have sent mixed signals, so I let the notice play out first.
Waiting is neither fun nor interesting, but it is safe.
About two weeks later, Steve notified me of something unexpected on his digital chart: his balance due had dropped by nearly $3800 and the disputed accounts were hidden.
They blinked.
In large healthcare institutions, that decision is not made lightly. The call had to come from high up, and not for just any reason. The notice I had mailed out had its intended effect: silos were broken, and the message reached either compliance or in-house counsel. They immediately identified the exposure and paused collections to mitigate risk. Most importantly for Steve and I, this was a clear signal that they were ready to begin working towards resolution.
Additionally, the specificity of what was hidden, and what remained on the balance sheet, told us that someone with authority had not only read the file but dissected it carefully.
But this wasn’t the time to celebrate. There was still a job to do and plenty of runway left for a negotiation to unfold.
A few weeks later, we received a reply directly from their legal team for the first time in nearly five months:
“We sent you a response letter on [Date Redacted] with our full responses and explanations to your concerns about the coding and charges on your accounts. In that letter we thoroughly explained that coding was correct, there were no duplicate charges, and pricing is within industry standards. At this time, we consider this matter to be closed and the balance on your accounts is your current patient responsibility.”
Given how everything had unfolded up to this point, I was surprised and even, on a hot take, a bit taken aback.
Tune in for Part 5 to find out more.