From where we left off in Part Five, the provider had informed us of their final position: no write-offs, no adjustments, no documentation, no deal.
The request for the administrative review was in the mail. This was our last-ditch effort to settle things amicably between patient and provider before the matter required external help. This could take the form of reporting to a regulatory body, which I do as an absolute last resort, or a lawsuit, which requires legal assistance that I do not offer.
However, we were no longer bound to the strict process flow of their internal resolution system. Technically, Steve retained any and all available remedies and could pursue them at any time — or he could choose to do nothing at all.
When I called Steve, I needed a way to soften the blow. Instead of the standard opener, “here is the bad news, now here are the options”, I opted for a different strategy.
Let’s say you received two bills: one for $600 and one for $1,400, but you only had to pay one of them. Almost anyone would pick the $600 bill because it’s cheaper.
The two bills correspond to two very specific courses of action. The $1,400 represents how much Steve would have to pay on uncontested and undisputed medical debts if the provider came forth and offered to write off 100% of all of the items we had chosen to dispute. This includes $600 on a clean, undisputed billing encounter and another $800 related to services properly rendered and uncontested within the disputed encounters.
If we were to continue fighting through regulatory channels in a bid to force a negotiation, and if the provider decided to write off 100% of all disputed line items, Steve would still have to pay $1,400 in services properly rendered.
Steve was in a highly enviable position. When entire billing encounters are challenged and placed under dispute, the entire encounter must be suppressed, even if it contains both disputed and undisputed line items. What that means is that if he chooses to do nothing and allow the accounts to remain in disputed status indefinitely, Steve actually stands to achieve another $800 in medical debt relief.
To be clear: this is not general advice to ignore medical bills, nor is it a recommendation for everyone. This outcome is specific to how this particular dispute was structured and flagged in the provider’s system.
This is what I call “Option C”: the disputed total is allowed to age out until it is written off by the provider as “uncollectible balances”.
To reiterate and to be absolutely clear, this isn’t an outright refusal to pay bills. In fact, I informed Steve that if he chose Option C, he should pay the cleanly uncontested $600 immediately and any future uncontested portions, when they do show up on his balance, should also be paid promptly to avoid unnecessary risk.
This isn’t an outright refusal to pay the other $800 wrapped up in disputed accounts. This is a strict result of how medical billing is structured. Paying these amounts is impossible when the entire accounts are flagged in digital billing systems. Second, any payment toward disputed accounts could be construed as settlement and can carry some legal ramifications that reduce options.
If at any given time the provider initiates a resolution, Steve becomes responsible for whatever remains. However, it is entirely up to the provider if they want to pursue that avenue or not.
Option C is also fraught with risk. They could initiate internal collections, pass the debt to a third-party collector, report to credit, or file a lawsuit to initiate wage garnishment.
We waited. Then the cleanly undisputed $600 portion was referred to a third-party collections agency. Just to be clear, this is 100% legal and above board, but it was another act of selective escalation in the same vein as their previous final determination letter.
To be honest, I had to think twice about acting. There was a brief moment where I considered another course of action, but something in the back of my mind told me to hold off on providing any further feedback.
“Don’t react. Just wait this out and see what happens”. After working so many cases, you start to develop a “sense” about actions and timing.
Technically, we didn’t have to provide a response at all. The dispute remains in effect. They could not touch the challenged accounts. On the other hand, we actually secured much more favorable terms with the third-party collector than we would have with the original provider. The balance was broken into arrears over several months.
Selective escalation or not, the scoreboard remained the same. They might recover the $600 undisputed portion, likely less after the collections agency takes its contracted fee, but $3,900 remained tied up in disputed accounts. My original PRAR only asked for $3100. The ball was still in their court, and the formal administrative review request was only days away from landing on their desk.
The waiting game continued.
Stay tuned for Part 7: Steve’s Conclusion.