Here’s a common scenario played out in business offices across the country. The words are different but the issue is the same; this one is health care related.

phone compassion
Photo by Denny Müller on Unsplash

A phone call comes in and your staff person picks it up.

“Hello, this is Mary. How may I help you?”

“My name is Sue Johnson and I just got a bill in the mail for my husband Donald. It’s from almost two years ago, and he died during this hospital visit. Why am I getting a bill now? How could you people be so heartless?”

At this point poor Mary doesn’t have a friend in the world. She’s probably not the one who sent the bill out. She feels guilty because she’s been put on the spot for what was either shoddy office work or processing problems that were finally resolved so a bill would go out. Either way it doesn’t matter, because the person on the other end of the phone feels she’s being badgered by the hospital, the very same facility that her husband died in.

Scenarios like this come without warning to business offices; it’s an area that’s rarely discussed. The problems are multiple, of course.

For one, even if it took a long time for a claim to be paid, unless it was for high dollars business offices won’t give them that much attention on a consistent basis.

Two, oftentimes some of the delay was due to business office inefficiency of another type (payment wasn’t posted to the correct account, allowances not taken at an appropriate time, incorrect insurance was billed, account never changed to self pay, etc).

Three, business offices are usually the last people to know that someone has passed away, or was critically ill. If claims are handled in a timely manner it doesn’t matter because all processes were followed properly and most people are calm and logical enough to recognize that they will probably be receiving a bill for balances after insurance.

Hospitals are supposed to be known for their compassion. On a hospital ward, nurses are supposed tend to patients with loving care. When patients have to go to ancillary departments for services and procedures, they deal with technicians who have probably received education as it pertains to addressing patient health concerns. These are all areas where patient contact is expected on a daily basis, and for the most part they know how to interact with patients well.

Let’s take a quick look at the areas left for discussion once you take ancillary departments out of the picture. There’s accounting, maintenance, housekeeping, food services, medical records, information services, registration, patient accounting, and switchboard. There may be others, but these will serve our purposes for the time being.

Out of all the departments above, which ones have the possibility of having to deal with the family of a patient months or even years after the date of service of a visit? Medical records possibly, but only to receive requests for records to be sent to some entity.


Patient accounting is the only other area out of the above where employees have the possibility of direct contact with the family members after the fact, and it’s probably the area that’s least equipped to deal with the issues. Most directors of patient services or office managers are pretty good at making sure billing people know how to process claims and follow up on outstanding claims. Most are pretty good at teaching personnel how to respond to specific billing questions.

Most are pretty good at instructing personnel how to handle irate customers who don’t like receiving bills. But we overlook the fact that hospitals not only deal with life, but also with death. Every other employee within the facility that has any patient contact has learned those lessons in advance and dealt with them; patient accounting personnel usually haven’t.

Those who have had to deal with this on a personal level know how we felt the day the first bill came from some medical entity requesting payment for a deceased loved one. Unless the account is self pay, you’ve usually gone a month or so trying to deal with the loss of someone you’ll never get to talk to again. We’ve had difficulties reconciling this fact in our lives, sometimes months later, when suddenly here comes a bill rom the last place we saw our family member alive. If it’s a self pay account it can be even worse; you could possibly receive a hospital bill before the funeral has been held. How’s that for good customer service?

The very nature of health care is that people get sick and need medical assistance. Sometimes they just don’t feel well; other times their illnesses borders on being critical. It’s bad enough if you’re the patient who has to deal with rising medical bills. It’s also hard on those family members who suddenly end up having to take over handling all bills for someone — not just medical bills —
during times of incapacitation.

Personally, I feel that any time a patient dies while in the hospital the bills should be submitted to insurance only, never to the families. I’d also love to have the ability to suspend submitting bills to patients or families in specific situations like those I mentioned above.

But I’m in health care finance. Those who provide the services deserve to be paid, and the hospitals deserve to be paid something for the services they provided, even if the patient dies in spite of the services rendered.

Hospitals should have a policy regarding the handling of these types of claims. The policy should start before the claim reaches the billing department. Procedures should be established so that whoever is responsible for entering the information on a deceased or severely ill patient has a way of notifying patient accounting of this patient’s status. A note or indication should go onto the patient’s account, highlighted so office staff can take the extra step of being compassionate.
Patient accounting staff members that are responsible for handling patient contact, either by phone or in person, should be educated on how to show compassion while talking to patients or family members. They need to be educated and given support on the reality that, in cases where the processes have been followed properly and family members are upset because they received any type of bill, they are only doing their job and following through with procedures they’ve been taught.

I remember as a young billing person having strong emotions when I had to send a bill to the family where the baby had died. We are all human, and patient accounting personnel usually hasn’t had any training in dealing with such issues. My team leader talked me through my personal issue, offering me the advice I offer above.

Most hospital personnel are taught something about compassion. Patient accounting has been left out of those discussions. Let’s try to remember that and take the time to rectify that situation.

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