Medical Billing Collection
Advice for Getting Patient Balances

Medical billing collection tips and tricks. Advice on how to collect patient balances without being pushy or rude, from medical billing professional Elizabeth Roberts.

I have been a medical billing and coding specialist for over eight years. Besides my daily responsibilities of coding claims, sending them to insurance, and filing appeals, I also have to work the patient AR. Patient AR, or Accounts Receivable, is one of the most difficult parts of my job.

Nobody likes to pay bills. Medical patients, who already pay expensive medical insurance premiums each month, are unlikely to pay without at least asking a few questions first.

Patient balances are usually due to visits that weren't paid by insurance, generally because they were applied to the deductible or coinsurance, or were for non-covered services performed in the office.

What this means is that the patient was seen in the office and the claim was sent to insurance, but the claim wasn't paid in full.

When this happens, the patient needs to pay the remaining balance.

It's hard asking people for money. I have to be careful about what I say and how I say it, to come across the right way. The best way to go about medical billing collection on these balances is to avoid being pushy or rude.

The last thing you want to do is make the patient angry with you - this makes it more unlikely that they will pay anything at all.

How it Works

A healthcare bill

There are two main ways which I deal with patient balances: in the office, and over the phone. Each one of these medical billing collection methods varies.

There are three parties in the American healthcare system:

  1. Insurance companies
  2. Patients
  3. Providers.

When insurance companies don't pay the full claim, it puts the responsibility for paying onto the patient's shoulders. The responsibility for collecting the claim falls on the provider's shoulders.

It's important to relate this to the patients. They only see a bill from your office, not the insurance company. It's the insurance company that is making them pay, not your office.


Patients often question the amount of the balance, and ask you why they have to pay it. There are a few tools to help you explain the balances. They are the insurance EOB and the patient's benefit policy.

An EOB is the explanation of benefits that comes with the claim. It explains how the claim was processed.

Even though patient receives a copy of the same EOB that you get in the office, they are often confusing and hard to read. I often have to show the patients where the insurance company decided not to pay. Many times, this helps answer the patient's questions.

Sometimes patients still need more information about why the insurance company processed the claim the way they did.

Even though patients should understand their benefits, it's often down to me to explain what their policy is and how insurance pays for a claim. It helps to show the patients their benefits verification.

This benefit verification can be done over the phone or online. It will show the patient's copay, coinsurance, and deductible amounts. Many offices perform this benefit verification every time a patient is seen by the doctor.

It's surprising how often patients don't know that they have a deductible, or that they're still responsible for a coinsurance amount after insurance payment. Using this benefits verification to back up the patient's bill always helps them understand why they still owe a balance.

Sometimes the patient balance is very large. Patients may be upset, angry, and downright defiant that they won't pay.

It's best to not make the situation worse by being impolite, disrespectful, or pushy. Being rude to a patient immediately makes the conversation go south, and may make it impossible to collect on a balance.

Office Medical Billing Collections

Trying to collect a patient balance in the office is always more difficult, since you're face to face with the patient.

In these cases, try to smile and express your understanding that paying bills isn't fun, and may be very difficult for some people. Never express your opinion that you think the patient is just being stingy or just doesn't want to pay.

Don't make it personal. Help the patient understand that you personally are not asking them to pay - it's the insurance company. Also help them understand that if they doesn't pay, the doctor won't get paid.

Try to get them to see where you're coming from, and that you're just doing your job.

Phone Collections

Some tips for collecting patient balances over the phone

Medical billing collection over the phone are a little different. Because you're not face to face, you can't show the patients a copy of their EOB or insurance benefits verification. It's important that you use carefully selected words and a light tone of voice.

There have been many times that I've wanted to just yell out, "Its only ten dollars!!". Sometimes you'll need self-restraint to help you get through the most difficult calls.

Here are some tips for a successful medical billing collections phone call:

  • Verify the patient's mailing address hasn't changed. Sometimes the reason a patient hasn't paid is because they haven't received the bills - simple as that!

  • Always be respectful. Never insult the patient.

  • Never belittle the patient or make them feel like they are deadbeats because they can't pay the bill.

  • Maintain a neutral face. It sounds funny, but you can hear it in your voice when you are smiling or frowning. Keeping a neutral face makes the phone call less personal.

  • Express your understanding that it may be difficult to pay a bill. A good line I always use is, "I understand that many people are having financial difficulties right now..."

  • Have a flexible timeframe. If a patient wants to speak to their insurance company before they pay you, give them some extra time.

  • Maintain a flexible payment schedule. Often it's easier for a patient to pay smaller amounts, rather than the entire bill all at once.

  • Be patient. Many times patients won't have all the money at once. Allowing them time to get their ducks in a row will help you get the entire balance paid.

Every time I make a medical billing collection phone call, it's like a roll of the dice. You never know who you'll get on the line, and how they'll react to you asking them for money.

It's intimidating, but following the above tips always helps me have better luck collecting from patients.

It's important to note, however, that some patients simply won't pay, no matter what. For whatever reason, they'll avoid phone calls, return mail unopened, and disappear from the office.

In these cases, it's important to have a pre-determined set of actions to follow for unpaid balances.

Will you send them to collections? If so, what's the minimum balance amount?

Will you continue to see the patient in the office? What will you do if the patient comes in for an office visit?

Having answers to these questions and a ready course of action will help you with medical billing collections. These tips and tricks make my job easier on a daily basis, and help me get those patient balances paid.

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