Billers are always trying to discern the difference between those who are unable to pay and those who are unwilling to pay. The more certain they are that someone is unable to pay, the more likely they will set up payment plans, give discounts, and waive balances9 . The more certain they are that someone is unwilling to pay, the more likely the account will go to collections. As I said earlier, not-for-proft hospitals have to provide charity medical care in the form of free care and write-offs or the IRS will slap huge penalties on them. And because so many physicians are becoming employees of these not-for-proft hospitals, the same rules are starting to apply for physician bills as well. They can and will do this, but they have to have some evidence of inability.

1)
Does this patient take and return our phone calls? You want the biller to view you as responsive and cooperative. Conversely, you absolutely don’t want to be viewed as non-responsive and uncooperative. If you have a message from a biller, return the call, even if it is just to tell them that you need time to understand your bills. If you see your biller’s number on caller ID, answer the phone. Do not ignore their calls hoping they will just go away. It is just as bad as ignoring the symptoms of a disease. It will not go away; it will just get worse.
2)
What do the notes on the account say? The notes on your account can save or destroy your chances to get a break. The best advocates you will have are the positive comments from another biller. Things like “called back promptly,” “good demeanor,” and “called to verifed payment received” are all positive things to have on your account notes.
3)
Has this patient been uncivil or caused problems in the past? Getting angry on the phone will get you sent to collections. Insulting the biller or being sarcastic are completely counter-productive and
  1. 9 Hospitals Share Insights to Improve Financial Policies for Uninsured and Underinsured Patients: A Report from HFMA’s Patient Friendly Billing Project, February 2005.
46 // The Medical Bill Survival Guide