Find patients who say they cannot pay their bill (US)

Fields

• Channel (call transcript, portal message, email, letter)
• Message, letter or call transcript

Questions

1. Is this a contact from a person about a patient's bill or account? Yes / No

   Count contacts from the patient, a parent, a relative, a carer, an attorney or an executor. Yes: A person got in touch about a patient's bill, account, charges or insurance. No: Spam, marketing, an auto-reply, a delivery failure notice, a contact about something other than billing, or a blank or unreadable text.

2. What is the main reason the patient got in touch with the billing office? Choice

   Read the whole contact. Choose the reason the patient or the person writing for them gives for getting in touch, not what the billing office offered in reply. If they give several, choose the one they say most about.

   • Question about a bill Asks what a charge is for, how much is owed or why a bill arrived, without asking for help paying.
   • Make a payment Wants to pay now, in full or in part.
   • Payment plan Asks to pay over time, and does not ask for help, a discount or charity care.
   • Help paying Says they cannot pay and asks what can be done, or asks about financial assistance, charity care, a discount or help with the bill.
   • Insurance update Gives new or corrected insurance details, or asks the hospital to bill a different insurer.
   • Itemized bill Asks for a detailed list of charges.
   • Dispute a charge Says a charge is wrong, duplicated, already paid or for care the patient did not receive.

3. Does the message say the patient is struggling to pay or cannot pay? Yes / No

   Count saying they cannot afford the bill, have fallen behind on other bills, have lost a job or income, are choosing between this bill and essentials, or asking for a lower amount or more time because money is short. A reason is not needed. Judge only what is said; do not infer difficulty from tone. Yes: The contact says the patient is struggling to pay or cannot pay. No: No difficulty is stated, or the contact only says the patient will pay.

4. What insurance problem, if any, does the patient describe? Choice

   Read what the contact says about insurance for this care. Choose the problem it describes. If they describe more than one, choose the one that explains why they were billed.

   • No insurance problem Insurance is not mentioned, or the patient says it worked as expected.
   • Not billed to the insurer The patient says the hospital did not send the claim, or sent it to the wrong insurer.
   • Denied by the insurer The patient says the insurer refused to pay some or all of the claim.
   • Coverage changed or uncertain The patient says their plan changed, their coverage ended or may have ended, or they have applied for Medicaid or other coverage.
   • Uninsured The patient says they had no insurance at the time of care.

5. Does the message dispute the bill or a charge on it? Yes / No

   Count saying a charge is wrong, duplicated, already paid, for care the patient did not receive, or for someone else, or asking for proof that the amount is owed. Yes: The contact disputes the bill, the amount, or a charge on it. No: The contact accepts the bill, even if the patient cannot pay it. Asking what a charge is for, or saying a provider was out of network, does not count on its own.

6. Does the patient describe a bill from an out-of-network provider for emergency care, or from a provider they did not choose at an in-network facility? Yes / No

   Read the contact. Count a bill from a doctor, group or ambulance the patient says was out of network for emergency care, and a bill from a provider the patient says they never chose or met, such as an emergency physician, anaesthetist, radiologist or assistant surgeon, for care at our hospital. Yes: The patient describes at least one such bill. No: No such bill is described.

7. Does the message say an attorney represents the patient on this bill? Yes / No

   Count a statement that the patient has hired or is working with an attorney or a legal aid lawyer on this bill, their medical debts or a bankruptcy, or a request that we contact their attorney, with or without the attorney's details. Yes: The contact says an attorney acts for the patient now. No: No attorney acts for them. A relative or friend helping, a patient advocate, a credit counseling agency, or a threat to hire a lawyer later does not count.

8. Does the message say the patient has filed for bankruptcy, or plans to? Yes / No

   Count a filing already made, a case number, a planned filing, or an attorney preparing one, under any chapter. Yes: The contact says the patient has filed for bankruptcy or plans to file. No: Bankruptcy is not mentioned, or only as something the patient wants to avoid, such as "I don't want to go bankrupt".

9. Does the message mention self-harm, suicide, or having no money for food, medicine or heat? Yes / No

   A contact like this should reach a trained person before anything else happens on the account. Yes: The contact mentions self-harm or suicide, or says the patient has no money for food, medicine, heat or housing. No: None of these is mentioned.

Lens columns

about_an_account, about_an_account_probability, contact_reason, contact_reason_probability, financial_difficulty_stated, financial_difficulty_stated_probability, insurance_problem, insurance_problem_probability, disputes_debt, disputes_debt_probability, possible_surprise_bill, possible_surprise_bill_probability, attorney_represents, attorney_represents_probability, bankruptcy, bankruptcy_probability, crisis_mentioned, crisis_mentioned_probability