Never-Ending Costs: When Resolved Medical Bills Keep Popping Up

Yves here. I hope no readers have encountered this sort of horror, zombie medical bills that you paid that refuse to die. One bit of advice: record your calls when you go to complain. In most states, it is legal to record your conversations without obtaining the consent of the other party.

The other part of this story that is appalling is the fact that the parents here feel they even have to take these supposedly written off bills seriously. Their adult son is dead. Unless they signed up as his financial guarantors with the hospital system, they have no liability. The son was broke so it’s unlikely that the parents are shielding assets in his estate.

If I were them, I would write a blistering letter to their general counsel about illegal debt collection practices and potential liability for improper care.

By Aneri Pattani, a Kaiser Health News Correspondent, has also broadcast on NPR and Science Friday and previously wrote for Spotlight PA, a collaborative newsroom investigating the Pennsylvania state government. Originally published at Kaiser Health News

Every now and then, Suzanne Rybak and her husband, Jim, receive pieces of mail addressed to their deceased son, Jameson. Typically, it’s junk mail that requires little thought, Suzanne said.

But on March 5, an envelope for Jameson came from McLeod Health.

Jim saw it first. He turned to his wife and asked, “Have you taken your blood pressure medication today?”

He knew showing her the envelope would resurface the pain and anger their family had experienced since taking Jameson to McLeod Regional Medical Center two years ago.

As KHN previously reported, Jameson was experiencing withdrawal symptoms from quitting opioids. Suzanne feared for her son’s life and took him to the emergency room near their home in Florence, South Carolina, on March 11, 2020.

There, they encountered a paucity of addiction treatment and the potential for high medical costs — two problems that plague many families affected by the opioid crisis and often lead to missed opportunities to save lives.

Jameson was not offered medications to treat opioid use disorder in the ER, nor was he given referrals to other treatment facilities, Suzanne said. The hospital wanted to admit him, but, being uninsured, Jameson feared a high bill. The hospital didn’t inform him of its financial assistance policy, Suzanne said. And he decided to leave.

Three months later, Jameson, 30, died of an overdose in his childhood bedroom.

In the following months, the Rybaks received bills from the McLeod Health system addressed to Jameson. He owed $4,928, it said. Suzanne called and wrote to hospital administrators until September 2020, when the bill was resolved under the system’s financial assistance program.

That was the last they had heard from McLeod Health until the new envelope arrived March 5 — one week before the two-year anniversary of his ER visit. That visit was what Suzanne calls “the beginning of the end for my son.”

When the Rybaks opened the envelope, they found a strikingly familiar bill for $4,928.

“I can’t even describe my anger and sadness,” Suzanne said. “It’s always present, but when we received that statement, we were just stunned.”

There’s no national data to indicate how often patients or their families receive medical bills that were previously paid or forgiven, but hospital billing experts say they frequently see it happen. Patients receive bills for claims their insurers already paid. A reminder statement arrives even after a patient submitted payment.

Unlike “surprise bills,” which often result from policy gaps when a provider is out of network, these are bills that were resolved but continue to pop up anyway. They can carry financial consequences — patients wind up paying for something they don’t truly owe or bills get passed on to debt collection agencies, triggering more phones calls and red tape. But often it’s the emotional toll that wears on patients most, spending hours on the phone with customer service each time the bill resurfaces or reliving the situations that led to the bill in the first place. For families like the Rybaks, the cost can feel never-ending.

Suzanne Rybak refused to engage with the McLeod hospital again but told KHN about the new bill.

In response to questions from KHN, McLeod Health determined the bill the Rybaks received was a mistake.

“Unfortunately our software system regenerated this statement due to a technical issue,” wrote spokesperson Jumana Swindler. “We are checking to ensure that it has not happened to any other patients and we are sorry this family was impacted by the error.”

A week after KHN’s inquiry, the Rybaks received a letter from the hospital explaining and apologizing for the error.

Many medical billing cases like this “boil down to human error,” said Michael Corbett, director of health care consulting for LBMC, a Tennessee-based firm that consults with health systems nationally on issues like billing and revenue. “Facilities don’t have a lack of tools [to avoid this]. It’s a breakdown in their processes.”

A billing agent may forget to mark the account as paid, he said. Or the hospital might contract its billing to an outside company and fail to inform them that this bill was covered under the hospital’s financial assistance program.

As hospitals and medical practices increasingly consolidate under large health systems, the chances for errors increase. Even hospitals and clinics within the same system may have different backend software, and within each hospital there can be separate programs for billing and electronic health records, Corbett explained.

Larger health systems may also have more people processing any given bill. If responsibilities are not clearly defined, multiple employees could unknowingly act on the same patient account.

The covid-19 pandemic has exacerbated potential errors, Corbett said. New medical billing employees may have received quick, virtual training and are working remotely with little interaction with team members or oversight. Some billing departments are understaffed, leading to delays in patients receiving bills or follow-up notices, he added.

To curb mistakes, Corbett said, hospitals need to invest in more comprehensive training and supervision for billing employees; enact consistent processes for anything from how patients’ financial information is collected at registration to when they’re sent bills; and, perhaps most important, track whether those processes are being followed.

For patients who find themselves in a situation like the Rybak family’s, Corbett advises calling the hospital billing department and asking to speak with a senior leader in its revenue cycle division. Unlike an account representative, this person could make decisions, Corbett said.

At the end of the conversation, ask to get the explanation in writing, he added.

“You’d anticipate and hope those notes are being recorded,” Corbett said, but that may not be the case. Or notes might get recorded in a section of hospital files that are excluded from a patient’s legal medical record, making it difficult for patients to access later.

For Suzanne Rybak, the idea of calling McLeod Health to straighten out yet another bill was too much. Instead, she added the statement to a binder of paperwork, in which she’s documented all her billing struggles with McLeod Health over the past two years.

Still, out of sight hardly means out of mind. The binder sits in her craft room, where she remembers Jameson encouraging her as she made beach bags and other items. He’d say to use “fruity colors,” Suzanne recalled — his way of describing tropical colors. Now she makes candles in that room, focusing on tropical fragrances she knows Jameson would have loved.

“I want hospitals to realize that you’re not just sending this bill to an address,” Suzanne said. “There are people who live in that house, who are going to open that mail and have feelings. … It’s a disaster to bring all that up again.”

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  1. Paul Art

    Between 1997 and 2004 when my baby daughter went through two heart surgeries I experienced this kind of supposedly erroneous duplicate billing. I the started keeping track of the bills I paid and put them in a file. On receipt of a new bill the first thing I did was to check if it was a repeat. I went through the elaborate process of calling the provider to prove it was paid. In 1997 the calamity of our health system was not widely known. When I shared my experiences with friends they had a hard time understanding because major sickness had not visited them. This is a big reason for how and why the greedy Physician-Insurer lobby gets away with blue murder. Major illness is diluted in the general population which prevents the forming of any kind of organic social protest and outrage. I also suspect that Medicaid and Medicare are two albatross corpses around the neck of Single Payer. Both programs neatly excise the two major political forces that usually engender momentum for awareness and change viz. the poor and the old.

  2. WillyBgood

    Jumana Swindler? SWINDLER!! It was hard to concentrate after that bit of cosmic irony.

  3. jackiebass63

    It is very important that people keep a record of all events involving health care. Things like appoints and treatments are important to keep.Also keep any communications from insurers. If I receive a bill from a provider the first thing I do is to check my insurance records to see if my insurance paid a claim and how much they paid. I refuse to pay any bill until I get information from my insurance about the claim. I do this because I had a bad experience with an Insurance company. Even few days I got a bill from a provider for a service. The bill was only for $20. I finally got tired of being billed so I paid the bill. Five days later I got a notice the insurance company paid the claim. It took me nine months to get a refund from the provider.Since then I don’t pay a bill until I get something from my insurance. Billing companies make it difficult to figure out if you owe something and how much you owe. They are usually very vague in what information is on the bill making it hard to figure outwit you are being billed for.

  4. Medbh

    This happened to me too. It was only for around $100, but I received and paid the exact same bill twice. I got another notice of it being over due and called to say there was an error, I had already paid it twice, and I wasn’t going to pay it again. The bill eventually went into collections and was recorded as an unpaid bill. There was no arguing with anyone about the bill. It didn’t matter that I had checks showing I paid that exact amount for the same clinic/doctor for the same date. The clinic’s bill was the only thing that mattered to anyone.

    The kicker was a year or two later I received a check for $100 from the clinic saying there was a billing mistake, but I never got the third one removed from my credit report. The health care insurance system is a complete scam.

    1. flora

      If it goes into collections it can be sold and resold, and that’s a problem contributing to zombie medical debt.

      If this happens to me, and it could, then on the mistaken second bill if I’d already paid the first bill, I’d call the billing office, explain the call, and demand an audit of my account, and request the result of the audit be mailed to me, on paper. They should be able to find their error with an internal audit, unless they are deliberately trying to double-charge people. Yes, a huge pain in the backside, an enormous time sink, and work you shouldn’t have to do if the provider has competent and honest billing office practices. Unfortunately, being right and ignoring the problem does not make it go away.

      (It’s odd medical outfits don’t send a receipt for payments, don’t ya think? Insurance cos and Medicare send payment notice receipts. Save all receipts of payment to medicos from all sources, including any personal cc statements or cancelled checks, etc. You did all that and still the clinic didn’t believe you which makes me to think it’s their practice to double bill people for profits, because Markets.)

  5. ambrit

    This “error prone” system pervades business.
    We just got a collection agency bill for a supposedly ‘outstanding’ final utility bill for the place where we used to live in Louisiana. We moved on from there over ten years ago. The bill is for $51.06.
    The “bill” is for an address in Louisiana.
    We now reside in Mississippi.
    The collection agency is in North Carolina.
    It’s a Nationwide enterprise.
    I have contacted the utility company for confirmation or negation of the bill and it’s date history.
    Till the utility gets back with us, no one gets nuttin, as the saying goes.
    I eagerly “look forward” to getting a call from Mr or Mz Smith from the collection agency. I will record that call. In fact, I should try and find the old suction cup type phone recording device I used to have. Otherwise, I’ll have to get a new one. [Would we class this as a “First World Problem?”]
    Stay safe. Remain vigilant.

    1. Jack

      Have them call you on a cell phone. There are many apps for smart phones that can record phone calls. I use Cube ACR myself. ALL of my calls are recorded. And I have had to use the recordings many times in the past. Its amazing when you get into a “he said, she said” situation and you then produce the recorded call. The most recent occurrence was just last year. And the company rep tried to tell me that it was illegal for me to record a call with out permission. Not! Like Yves said, most states allow you to record calls without even having to notify the other party that you are doing so. I am in SC and that’s the law here.

      1. ambrit

        That’s also the law here in Mississippi.
        The state of play is mixed, as one would expect from a mixed Republican Federal system.
        A law office info-dump:
        I have had a woman calling from a medical office collection department ‘terminate’ the conversation when I remarked that I too was recording the conversation. (They wanted to record it for “quality assurance purposes,” but balked at my claiming a similar right.)
        Be safe! Proudly join in the “Masque of the Covid Death.”

    2. flora

      The .06 on the bill is a nice touch. / ;)

      I have a fairly common name and also a landline, so an easily found telephone number and address. I get a lot of these calls. They always sound a bit menacing, (I know they’ve called me in error, so I don’t get flustered). When I say they have the wrong person they then eventually ask for my ssn – which I never ever give to them. I ask them for the last 4 digits of the ssn of the person they’re looking for. Often times they say they won’t give out that info, but if I persist, they usually do. It’s never me they’re looking for. If they threaten my credit rating I say, “go ahead”, knowing they don’t have my ssn.

      Good luck getting these vermin out of your life.

      1. ambrit

        Thanks. I too wondered about the $.06 bit.
        I always find it ‘enlightening’ that the collection agency is generally situated in a distant place. Letterheads are easy to fab up. I once encountered a dodgy business that used a ‘Mail Service’ store address as their location.
        If it turns out to be a fishing expedition by a bottom feeder outfit, Phyl suggests that we send them, by certified mail, a bill for the time and labour used in ‘verifying’ and ‘rebutting’ the claim. Then send a copy of said to the Carolina State Attorney General’s Office. [Make sure to cc: that on the original Phyl emphasizes. In fact, she said to cc: the complaint to as many organizations as possible.]
        I wonder if private individuals can sue for fraud?
        Stay safe!

        1. John Zelnicker

          Hi, ambrit – As someone already said, bills, even paid ones, can get sold through a series of collection agencies. If the first one can’t collect, it will sell the tough ones to another collection agency, eventually getting down to the gutter type agencies.

          If such a bill ends up on your credit report, you can demand that the credit bureau verify the debt with the original creditor. They have, IIRC, up to 90 days to respond to your demand.

          If the debt cannot be verified, they have to remove it and also notify the other credit bureaus to remove it.

          I’ve had to do this a few times over the years.

          Best to you and Phyl.

          1. ambrit

            Thank you for the information. News we can use. The “resurrection” of old bills has a distinct “No One Ever Expects the Spanish Inquisition” feel to it.
            Stay safe there by the bay!

  6. Cat Burglar

    My hospital in Mammoth Lakes California had no incentive to avoid false billing. If you don’t have to pay them, they only lose the cost of paper and postage, but if you do pay, they hit the jackpot! When the hospital chose a billing contractor, they apparently took the low bidder.

    When I got a bill for over six thousand dollars over a year after my fully insurance covered operation, they told me that “the computer did it.” They said it wouldn’t happen again. Next month it happened again, and they promised an itemized billing.

    A hospital VP promised me a signed letter showing I owed nothing, and I got it. She promised me that it wouldn’t happen again, and it didn’t — the next false bill was for only five thousand dollars. All I had to do was leave a phone message that time, and duly received my next letter from her saying I owed nothing.

    I guess the false bills were errors, and not a criminal shakedown — but if it were a criminal operation, how would it be different?

  7. Susan the other

    It would be good to make the “billing department” or “accounts department” liable for these “mistakes.” They operate with full immunity it seems. And if you’ve ever had a conversation with one of their “representatives” you’ve probably learned they are all robots. Worse than trying to talk to a computer receptionist. When you’ve done your homework and you know the bill is bogus and you get sent to talk to a certified twit in billing who tells you that you are wrong and this is the “way” the hospital bills “these things” – the only place you have left to go is to small claims court. So my solution at this point in our great medical farce would be to construe a fully legal People’s Medical Court – based on a new law that codifies (and in detail) health care as a human right; a court fully authorized to handle these problems and require a chain-of-custody for evidence of services performed in plain English – and impose discipline and serious fines, and etc. Having to answer to a medical court of law might change everything. Dream on. Let’s ask Nancy, because, gosh Nancy, it all just seems so criminal, doesn’t it?

    1. flora

      Private Equity outfits now own so many hospitals and doctor/medical groups, and have I’m sure forced above said to adopt the new PE owners’ favored computerized billing software, that, um… not sure where I’m going with this. / ;)

      1. Susan the other

        Yes. Our podiatrist told us that he had joined the local hospital group as an independent office renter, with a temporary contract while he builds his own clinic, and they are already trying to force him out early for a new high-ticket tenant. He also said that they take a cut of his earnings and that in fact he wasn’t even sure “what he was making.” I told him I thought this corporation was a bunch of sleaze bag profiteers and he agreed. I also told him that the corporate practice of medicine (like they are doing) is illegal and there’s a big lawsuit brewing in California. He didn’t know about that law. Which I thought was probably one way the corporations and PE are getting away with all their profiteering – nobody even knows that it is illegal.

  8. Jokerstein

    Everybody needs to be aware of the Fair Debt Collection Practices Act. I’ve used it a couple of time to get duns off my back.

    There are lots of template letters out there. I’m not saying it will work for everyone every time, but I have had 100% success rate in making these leeches disappear, as have people in my family.

  9. Jesper

    A cynic might believe that if the errors were made in the favour of the patient/customer at a cost to the provider then the errors would soon disappear but fixing errors that cost the patient but favours the provider are for some reason often more complicated to fix and therefore more time-consuming.

    I suppose these kind of things can be either due to honest mistakes or by design. One indication, but not a guarantee, that it might be an honest mistake is how quickly a correction is made. Honest enterprises might be expected to fix honest mistakes quickly.

    Giving managers targets to minimise the number of mistakes made seems like a good thing and measuring the success of the manager in minimising the number of mistakes made by counting the number of mistakes being fixed might make sense to some. For others then such a metric will become a target in itself and the easy way of reaching that target is by not fixing mistakes.
    Not fixing mistakes is quite easy, the difficulty might be in avoiding being seen as not fixing mistakes. One way of not detecting mistakes is making the process for detecting (or rather verifying) mistakes complicated and work-intensive (costly). The justification for having such a process is of course not to not fix actual mistakes, the justification is to minimise the risk of fraud.
    The incentives are quite strong for individuals working in large organisations to not fix things like this.

    Only way that I can see things like described above to be fixed is if outside pressure is applied & even then I’d say it is a long-shot. Regulators who regulate usually do not last long until industry asks for a more business-friendly regulator. Law-suits are complicated, risky and even class-action law-suits might not meet the risk/reward criteria so might not happen and if successful might not even be a deterrent.

  10. fresno dan

    I’ve been recounting my run in with a series of hospital bills from last year. The bills have finally been turned over to a debt collection agency. The debt collection agency finally got the original biller to submit the charges to my health insurance company. So the health insurance company paid about 10% of the charges, and I am due for the rest.
    The issue could be pursued by me, but I am tired of it, and fortunately I am well off enough that I can pay it. So my health insurance company has a deal with the hospital that what it pays for a hospital provided service is what the hospital will accept. So far so good, but the problem arises that so many of the “providers” at the hospital are “independent” service providers and not actually hospital “employees”, and apparently there is no standard that constrains how much they can charge. And as I am finding out getting a detailed explanation of services charged from the hospital does not include these “independent” service providers, and getting a detailed explanation from them (i.e., the independent service providers) is apparently something not required by law. I remain unconviced that a doctor I never saw, who apparently only signed (if he in fact did) a form, (and what this form is) should be paid one thousand dollars, is an appropriate and justified expense.
    But such is our vaunted medical billing practices…I contemplated hring an attorney, but I am sure that would run into more money than its worth, but if I were rich, I would do it for retribution.

    1. ambrit

      A much cheaper and more cost effective method of combatrting such practices would be to establish an “Instant Karma Commando” to apply direct kinetic solutions to the people responsible for the policies that generate the problems. Illegal as H—, but, in today’s climate of “Might Makes Right,” a parrallell institution that challenged the government’s claim to the exclusive use of violence would be just an expression of the Zeitgeist.
      [Boy am I going to get dinged for this. In my defense, this really is the trajectory of the Civil Society in America today. What else was the nationally coordinated “dismantleing” of the Occupy Movement by the Organs of State Security during Obama’s Reign but the application of violence to stifle dissent?]
      Stay safe!

    2. flora

      The issue could be pursued by me, but I am tired of it, and fortunately I am well off enough that I can pay it.

      Please insist on a paper receipt from said hospital upon your payment of their bill. A signed and dated receipt. My 2 cents.

  11. Hotei

    When I receive incorrect billing notices from any company, I send my terms of engagement reply to them. I inform them that I bill $100 per hour for my time, in 1 hour increments.

    I provide one time evidence that the bill has been paid. Any further investigation on my part requested from them will incur my billing. “You indicate acceptance of my terms by sending any followup requests for information or billing”.

    This technique has worked every single time. I suspect it kicks the issue up to an employee who can take care of the matter and figures it is not worth wasting any more time with me.

    I then add a CC to my attorney at the bottom (which I don’t bother him with).

  12. ArvidMartensen

    60 years ago my parents bought a block of land and used a US affiliated company to provide the loan. Thereafter they regularly got demands that they had missed a payment.
    My mother was meticulous with records and could always find the receipt for said “missing payment”
    I realised later it was a business model.
    So this scam has been going on for a very long time
    I imagine that many probably received these same notices, and for those not as organised as my mother, they would have had to have paid twice. Ka-Ching!

  13. Big Tap

    I have on several occasions received duplicate hospital bills. When I pay a bill I keep the receipt either paper or from my computer. The invoice numbers are usually different so I let them know I paid their bill and tell them what the original invoice number was I paid. Probably been lucky but haven’t yet got a third bill. Also to eliminate
    duplicate bills I pay ASAP. It’s important to keep receipts.

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