cheese” at the American Hospital Association or the Ambulatory Surgery Center Association, I would make a policy that said:

Financial aid should be extended to patients who have elective procedures, as long as the patient applied for the fnancial aid and agreed to the terms before the procedure was performed. Financial aid may also be granted if some qualifying life event has occurred since the procedure was performed like loss of employment, change in insurance status, divorce, death of a spouse, and so on.

So, remembering that this a gray area where there really are no rules, it is my opinion that fnancial aid can and should be extended to patients who have elective procedures as long as the patient communicates hardship prior to service or if a qualifying life event has occurred to change the patient’s circumstances since the procedure was performed.

Only “escalate” issues to a higher authority if you absolutely have no alternative. When you “go over someone’s head,” you run a high risk of damaging your relationship with that person. You don’t want to do this, because you probably will have to interact with the lower level person on a more regular basis. A prime example is telling a biller that you want to speak to his or her supervisor. You may or may not get the result you want, but the supervisor will still hand the phone back to the biller afterward.

If you do have to escalate, you want to do it calmly and rationally. You will feel more comfortable if you understand how billing departments are set up.

At a hospital, the billers probably work in a department called Patient Accounting, Patient Billing, or Patient Financial Services. Billers report to managers who report to Directors who report to VPs.