Colorado’s UCHealth Debt Collection Process Triggers Criticism

In a collaborative investigation that included KFF Health News, The Colorado Sun, 9News, and others, the UCHealth (UCH) system has come under criticism for the volume of overdue patient billings that it turns over to collection agencies. A specific criticism is that this process typically keeps UCHealth’s name off collections documents and related legal paperwork, which critics say lacks appropriate transparency.

The news investigation found that in the last five years, UCH patients have been sued close to 16,000 times for money owed, and most of those lawsuits were filed in the name of debt collectors working for the hospital system. Hospital representatives say this is logically done because UCHealth signs over “all rights, title and interest” in the debt to the collection agency, which takes over from there. But Adam Fox, the deputy director of the Colorado Consumer Health Initiative, a consumer-advocacy group that helps patients in disputes over medical bills, is quoted as saying, “It makes it really hard for the patient to untangle.” This gets exacerbated by instances where billings are inaccurate, a somewhat common occurrence in hospitals in general.

Colorado’s Largest Hospital/Clinic Network

UCH is Colorado’s largest hospital system with a network of 14 hospitals and more than 200 clinics that treat almost 3 million patients per year. The network reportedly collects more than $6 billion a year in revenue from patient care. The investigative report quoted the health system as saying it collects about $5 million per year from lawsuits, which represents only 0.07% of the net patient revenue. UCH further pointed out that at a time of rising costs and budget crunches, it is providing more uncompensated care, which includes charity care that it has decided to provide for free, as well as bad debt, plus shortfalls in Medicare and Medicaid payment rates. UCH said this amounted to $580 million in the most recent fiscal year, a more than $200 million increase over 2019 numbers.

A KFF investigation in 2022 reportedly found that about two-thirds of hospitals across the country have policies that allow them to sue or take other legal action against patients. The Sun and 9News investigators found that some other healthcare systems in Colorado also use collection agencies the same way as UCH does, while others do not. According to UCHealth, patients receive information about prices and available financial assistance even before their scheduled visit. They then receive as many as seven financial assistance letters, four billing statements and two phone calls before the bill is sent to collectors.

Representatives from UCH were also quoted as saying their network does upfront screening to check patients’ eligibility for financial help and that if at any time during the process a patient contacts UCH to work out a payment solution, they should be removed from the collections process.

What Coloradans Can Do about Difficult Medical Billings

As John Ingold of The Colorado Sun reported in July 2023, dealing with a complicated, expensive medical bill is all too common in America. He noted that according to a recent Colorado Health Access Survey, more than 1 in 10 Coloradans reported struggling to pay medical bills. This rose to more than 1 in 3 for people who received surprise bills. Ingold also reported that more than half of those who struggled to pay medical bills said they took on credit card debt to do so, and close to 40% said their bills made it hard for them to afford necessities like food or heat. He added that roughly 12% of all respondents said they put off getting needed medical care due to fears about the cost.

Real-world stories abound about how medical billing makes people struggle. Cherished family keepsakes are pawned to find funds. 90-minute exams in an emergency room bill out at more than $25,000. A 30-minute ambulance transport clocks in at over $4,000. Battles with insurers over coverage often ensue. In some instances bills that have been marked as paid resurface as still owed. Through all this, people find their healthcare facility billing departments difficult to navigate, and the right live person who can help difficult to find.

Colorado’s Consumer Assistance Program

Ingold quoted Stephanie Arenales, the director of Colorado’s Consumer Assistance Program (CAP), as saying, “There’s certainly no lack of people who need help with their medical bills.” CAP is part of Colorado’s Consumer Health Initiative (CCHI), a program that helps people, at no cost, to contest their medical bills. Ingold says CCHI shows people how to navigate issues among insurers, hospitals, health care providers, and medical billers. At the time of his 2023 report, the program had helped more than 2,600 people with a combined savings exceeding $7 million.

Ingold said CCHI’s methods provide a guide for how people can fight expensive medical bills on their own. He listed the following key steps:

  1. Take it slow. You may have an urge to get a bill out of the way. But it’s best to wait until you have all the relevant paperwork and all questions answered as completely as possible. But do tell insurers, healthcare providers, and other appropriate parties that you are challenging the bill. Tell bill collectors the same.
  2. Gather needed information. This includes billing statements, explanations of benefits, insurance plan details (including summary and evidence of coverage), how treatments or procedures were coded, doctor’s notes, medical records, in-network vs. out-of-network provisions, what constitutes a surprise billing. (See https://doi.colorado.gov/insurance-products/health-insurance/health-insurance-initiatives/federal-no-surprises-act/colorado to learn how Colorado protects patients against surprise billings.)
  3. Learn. Learn as much as you can about diagnosis and procedure codes, benefits language, coverage exceptions, etc. See CCHI’s website at https://cohealthinitiative.org/ for information on the basics of health insurance and medical billing. The Colorado Division of Insurance — the state agency that regulates some, but not all, health insurance plans in the state — has educational resources at https://doi.colorado.gov/health-insurance. Learn also about the hospital’s financial assistance program for people with lower incomes. Hospitals are required to tell uninsured patients about such programs, but insured patients may qualify, too.
  4. Document. Record everything you learn — whether you learn through hard copy material, email, phone conversation, online patient portal, your own research, or any other method.
  5. Be willing to complain. If your efforts hit a wall, try filing a complaint with the proper regulatory body. The Colorado Division of Insurance handles complaints against insurance plans that it regulates. (The agency also has an informational flyer called “When Your Health Insurance Company Says No.”) The state Division of Professions and Occupations may take others (https://dpo.colorado.gov/FileComplaint). The federal Centers for Medicare and Medicaid Services fields other complaints, including some for people not covered by either Medicare or Medicaid. Two sites with helpful guidance on how to deal with Medicare and Medicaid problems are https://www.nolo.com/legal-encyclopedia/medicare-appeals and https://www.ncoa.org/article/how-to-start-the-medicare-appeals-process. If you’re not sure where your complaint should go, CCHI may be able to help guide you, possibly with just a quick phone call.
  6. Ask for help. Be ready to acknowledge when you feel you’re in over your head. You will be far from the only one who is confounded by the maze of medical billing. This may be the time to reach out to CCHI’s Consumer Assistance Program (https://cohealthinitiative.org/).