In response to KHN’s questions, McLeod Health determined that the bill Rybaks received was an error.

“Unfortunately, due to a technical issue, our software system regenerated this statement,” wrote spokesperson Jumana Swindler. “We are checking to make sure it has not happened to any other patients and we are sorry this family has been wrongly affected.”

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

Not a Modern Healthcare subscriber? Sign up today.

Many medical billing cases like these “come down to human error,” he says Michael Corbett, Director of Healthcare Consulting at LBMC, a Tennessee-based firm that consults with the nation’s health systems on issues such as billing and revenue. “The facility is not short of tools [to avoid this]. This is a breakdown of their process. “

Billing agents may forget to mark accounts as paid, he said. Alternatively, the hospital may contract the bill with an outside company without telling them that the bill is included in the hospital’s financial assistance program.

as a hospital and medical practice increasingly consolidated Under large health systems, the chance for error increases. Even hospitals and clinics within the same system may have different back-end software, and within each hospital can have separate billing and electronic health record programs, Corbett explained.

Larger health systems are also likely to have more people handling any given bill. If responsibilities are not clearly defined, multiple employees may unknowingly take action on the same patient account.

The COVID-19 pandemic has exacerbated potential mistakes, Corbett said. New medical billing employees may have received rapid virtual training and are working remotely with little interaction or supervision with team members. He added that some billing departments were understaffed, causing delays in patients receiving bills or follow-up notices.

To curb mistakes, hospitals need more comprehensive training and oversight of billing staff, Corbett said. Develop consistent processes from how patients’ financial information is collected at registration to when they are billed; and, perhaps most importantly, track whether those processes are being followed.

For patients who find themselves in the Rybak family’s situation, Corbett recommends calling the hospital’s billing department and asking to speak with a senior leader in their revenue cycle department. Unlike a customer representative, this person can make decisions, Corbett said.

At the end of the conversation, a written explanation was requested, he added.

“You would expect and want these notes to be recorded,” Corbett said, but that may not be the case. Or the notes might be recorded in a section of hospital files that are excluded from the patient’s legitimate medical records, making it difficult for the patient to access later.

For Suzanne Rybak, the idea of ??calling McLeod Health to settle another bill was too much. Instead, she added the statement to a file binder documenting all of her billing battles with McLeod Health over the past two years.

Still, being out of sight and out of mind doesn’t mean out of mind. The binder is in her craft room, and she remembers Jameson encouraging her as she made beach bags and other items. He would say to use “fruity colors,” Susannah recalls—that’s how he described tropical colors. Now she’s making candles in that room, focusing on tropical fragrances she knows Jameson will love.

“I want hospitals to realize that you don’t just send bills to one address,” Susannah said. “There are people who live in that house and they’ll open that mail and feel it. … It’s a disaster to bring it all up again.”

Kaiser Health News is a national health policy news service. It is an independent editorial project of the Henry J. Kaiser Family Foundation, which is not affiliated with Kaiser Permanente.