Healthcare spending has reached $4.8 trillion, and more of that cost is falling directly on patients—putting providers in a tough spot between compassion and cash flow. We break down why traditional medical debt collection damages trust, visibility, and revenue—and why it’s no longer sustainable.
We then explore a smarter alternative: integrated collection services, using BillFlash as a real-world example of how automation can restore control, transparency, and empathy to the billing process. The takeaway? When collections are built into care, providers get paid faster—without losing patient trust.
Tune in today.
Transcript
Narrator: 00:00
Welcome to the Billing Blueprint Podcast, your go to resource for innovative medical billing solutions. Each episode we explore the latest industry trends and share proven strategies to help your practice streamline operations and get paid faster. Now here are your hosts, Brad and Sarah.
Brad: 00:20
Okay, I have a number for you. I want you to just sit with it for a second. Really let the weight of it settle in. $4.8 trillion.
Sarah: 00:31
Wow.
Brad: 00:32
That is a 4. A 8. And just a staggering amount of zeros trailing behind it.
Sarah: 00:38
It's a number so colossal, it almost loses its meaning. It sounds more like abstract math than, you know, real money.
Brad: 00:44
Right. And that's what the US spent on healthcare in 2023. It's almost hard to wrap your brain around a figure that big.
Sarah: 00:51
It is. But here's the thing we often forget when we hear these massive stats on the news. We assume that money is just moving between, like, giant institutions.
Brad: 00:58
Sure. Insurance conglomerates wiring billions to massive hospital systems.
Sarah: 01:03
Exactly. Corporate money moving through corporate pipes. It feels distant.
Brad: 01:07
And that's the comfortable assumption to make.
Sarah: 01:08
Yeah.
Brad: 01:09
But the reality when you look at the data is quite different. A significant and growing chunk of that 4.8 trillion isn't coming from insurers or government programs or Medicare or Medicaid. No. Coming out of pocket. Your pocket, my pocket. We're talking about high deductibles. Co pays. All the surprise services that just aren't covered.
Sarah: 01:29
Exactly. The rise of high deductible health plans has fundamentally shifted the financial burden in this country. And that creates this incredible tension which is really at the heart of what we're talking about today.
Brad: 01:40
Yeah.
Sarah: 01:40
If you're a doctor, think about your mindset. You went to medical school to heal people. You took an oath to do no harm.
Brad: 01:47
Right.
Sarah: 01:47
But you're also running a small business. You have lights to keep on, staff to pay, very expensive equipment to lease.
Brad: 01:55
So what happens when the patient you just treated simply can't, or maybe won't pay the bill?
Sarah: 02:01
That's the question.
Brad: 02:02
Seems like an impossible position. It's that classic conflict between being a compassionate caregiver and, well, the cold financial reality.
Sarah: 02:11
The landlord still wants his rent check.
Brad: 02:13
And historically, the way the healthcare industry has handled that conflict spirit, specifically when a bill goes unpaid, has been, to put it mildly, a disaster.
Sarah: 02:21
Disaster is a fair word for it. It's been efficient in some ways, but destructive in almost every other way that really matters.
Brad: 02:28
So today, we're doing a deep dive into the murky, often dreaded world of medical debt collection. And before you tune out thinking this is Going to be some dry finance talk. Stick with us.
Sarah: 02:39
Please do.
Brad: 02:39
Because this is actually a story about how technology is trying to save the doctor patient relationship from being destroyed by money.
Sarah: 02:47
It really is.
Brad: 02:48
We're looking at the old way, using traditional debt collection agencies versus the new way, something called integrated collection services.
Sarah: 02:56
And the difference is stark. I mean, it's not just a software update. It's a complete philosophy change. We're going to look specifically at how a system called BillFlash handles this because the contrast really highlights the whole evolution of the industry.
Brad: 03:08
But we have to start with the old way to understand why the new way even matters.
Sarah: 03:12
You have to.
Brad: 03:13
I think most people have a vague idea of what a debt collector is. You picture like a boiler room, phones ringing off the hook, maybe some aggressive shouting.
Sarah: 03:22
That stereotype exists for a reason. In the traditional model, the workflow is just so disjointed.
Brad: 03:29
How so?
Sarah: 03:29
A medical practice realizes a patient hasn't paid. They try to follow up, maybe send a few letters. They fail, and then out of frustration, they just package up that debt and send it out to a third party agency.
Brad: 03:39
You know, I have this analogy in my head I can't shake.
Sarah: 03:42
Okay.
Brad: 03:42
It's like you own a really nice car. You love this car, but you need it detailed. So you drive it to some shady parking lot, hand the keys to a guy you've never met, and he just drives off with it.
Sarah: 03:53
Oh, that's good.
Brad: 03:54
And you just hope he brings it back clean and without any scratches. That feels like the old way of debt collection.
Sarah: 04:00
That's a very vivid and slightly terrifying analogy. But in terms of the loss of control, you're spot on.
Brad: 04:07
Yeah.
Sarah: 04:08
This is what we call the black box problem. The source material highlights this as a major pain point for providers. Once an account is turned over, the doctor loses all visibility.
Brad: 04:18
So once the file is sent, that's it. It's just gone. They can't see what's happened?
Sarah: 04:23
Essentially, yes. Gone. The doctor doesn't know when the patient is being called, what is being said to them, or how aggressive the tactics are getting.
Brad: 04:31
And the agency's only incentive is financial, right?
Sarah: 04:34
Purely financial. They get paid a percentage of what they collect. They are not incentivized to preserve the doctor's relationship with the patient. They're incentivized to extract payment, period.
Brad: 04:44
That's terrifying for a doctor who cares about their reputation. You spend years building trust with the patient and then suddenly some stranger is calling them at dinner time demanding money.
Sarah: 04:54
In your name, and that leads to relationship damage. It's one of the biggest downsides the sources identify. The irony is just. It's palpable. The doctor heals you, but their debt collector hurts you.
Brad: 05:06
They're burning the bridge to get the toll money.
Sarah: 05:09
That's a perfect way to put it. They don't care if that patient ever comes back to your clinic. They just want the commission.
Brad: 05:15
There's also a mechanical issue here, isn't there? It's not just about feelings. The actual process of sending the debt over sounds like a nightmare.
Sarah: 05:22
Oh, it's incredibly manual. We're talking about the swivel chair effect.
Brad: 05:25
Swivel chair?
Sarah: 05:26
Yeah, a billing clerk has to look at one screen, print out a report, physically collect account info, fill out submission forms for the agency. It sounds like something from 1995, which.
Brad: 05:38
Just screams human error to me.
Sarah: 05:40
Absolutely. If you mistype a balance, you're trying to collect the wrong amount. If you mistype a name, you could be harassing the wrong person. It's a huge liability.
Brad: 05:48
Not to mention the time it takes.
Sarah: 05:50
Exactly. Time that staff could be using to actually help patients.
Brad: 05:53
And here's the part that really surprised me in the reading. Let's say the agency succeeds. They actually get the money. Does the doctor get paid right away?
Sarah: 06:02
Often? No. And this is a huge friction point. Most people don't realize.
Brad: 06:05
So they just hold the money.
Sarah: 06:06
They hold it. They collect the money. And they might hold it for a week, a month, sometimes longer, before they remit the doctor share.
Brad: 06:13
Wait, why are they just earning interest on it?
Sarah: 06:15
Partly that, and partly just inefficient batch processing. But for the doctor who's already waiting months for the patient to pay, now they're waiting again for the agency to release the funds. It suffocates cash flow.
Brad: 06:27
So to summarize the old way, you lose control. You have no idea how your patients are being treated. You do a ton of manual paperwork, and. And even when it works, you still have to wait for your money.
Sarah: 06:37
That's a pretty damning but, yeah, very accurate summary. It's a system that's just built on friction.
Brad: 06:44
Okay, so let's pivot because the source material suggests there is a new way. They call it Integrated Collection services.
Sarah: 06:51
Right.
Brad: 06:51
And the example they use is BillFlash. Now, integrated is one of those buzzwords that gets thrown around all the time. What does it actually mean here?
Sarah: 06:59
Think of it less as hiring a mercenary and more like installing a new feature directly into your car's dashboard.
Brad: 07:06
Okay, I like that.
Sarah: 07:07
Integrated services aren't an outside hired gun. They are a Workflow that is ingrained directly into the provider's own billing software.
Brad: 07:15
So it's not a separate company you have to email spreadsheets to.
Sarah: 07:18
Precisely. It connects via an API directly to the practice management system the doctor is already using. The data just flows back and forth securely. And this integration, it changes the entire workflow.
Brad: 07:29
So the source walks through a few steps, right?
Sarah: 07:32
Yeah, four steps that really highlight the difference. Starting with something called auto identification.
Brad: 07:37
Okay, that sounds convenient, but also a little risky. It makes me think the computer's just deciding who gets sent to collections.
Sarah: 07:45
It sounds that way, but it's more about filtering. Instead of a billing clerk digging through files to find who hasn't paid, the system uses rules set by the provider.
Brad: 07:55
Ah, so the doctor sets the rules.
Sarah: 07:57
Exactly. The doctor says, show me everyone who is 90 days past due and owes more than $50. The system automatically flags those accounts. Gets rid of that whole hunting and gathering phase.
Brad: 08:09
Okay, so the computer identifies the targets, but it doesn't pull the trigger. Because I'd be worried about a glitch sending my grandmother to collections.
Sarah: 08:18
And that's why step two is my favorite part of this whole workflow. It's the safety valve, or as the source calls it, the provider review.
Brad: 08:25
I love this. It's a sanity check.
Sarah: 08:26
It is so crucial for maintaining that human element. The system generates the list, but before anything happens, the doctor or the office manager gets to review it on their screen. On their screen. And they can say, wait, Mrs. Johnson. No, remove her. I know. She just lost her husband. We're gonna handle that differently.
Brad: 08:43
That's the control coming back. You're not just handing the keys to the stranger anymore.
Sarah: 08:47
Exactly. You're deciding who gets a ride. It allows for compassion. But once you click approve, we hit step three. Automated transfer.
Brad: 08:54
No forms, no typing.
Sarah: 08:55
None. The systems are integrated so the data sends securely and immediately, which, as you said, eliminates that human error risk. No fat fingering the balance.
Brad: 09:05
Right. And then step four is the engagement.
Sarah: 09:07
Yeah, the system starts sending letters and calls, but the source material really emphasizes that this engagement, it feels fundamentally different than the old way.
Brad: 09:18
This gets us to the empathy factor. The source says these specialists are trained specifically in medical debt sensitivity.
Sarah: 09:25
Medical debt sensitivity? It's a phrase that probably shouldn't have to exist, but I'm really glad it does.
Brad: 09:30
It sounds a little like marketing speak. What does it actually mean in practice?
Sarah: 09:34
It means understanding that owing money for a surgery is not the same as owing money for a jet ski.
Brad: 09:39
Right. Consumer debt is usually voluntary. You bought the thing.
Sarah: 09:42
Exactly. Medical debt is often involuntary. You didn't choose to get sick. So the communications from these integrated services are transparent. The tone aligns with the practice's values. The goal isn't to scare the patient.
Brad: 09:56
It's to work with them.
Sarah: 09:57
It's to work with them. It's a consultative approach, not a combative one. It changes the dynamic from pay me to how can we solve this?
Brad: 10:06
It seems like transparency is a big theme here. In the old way, you have the black box here. The source says the data acts as a single source of truth.
Sarah: 10:15
And that is a huge benefit for the clinic's admin side because it's all integrated. The provider can see real time updates.
Brad: 10:22
Inside their own software, so they know exactly what's happening.
Sarah: 10:25
Did we send a letter? Did they call back? Did they make a partial payment? It's all right there. You're not guessing. If the agency's doing its job, you can see it on your dashboard, which.
Brad: 10:33
I imagine saves a ton of time.
Sarah: 10:35
Massive amounts of time. The automation reduces manual errors, and it means you don't need to hire extra staff just for collections. It leads to significant cost savings.
Brad: 10:44
Okay, I want to drill down a bit more on Bill Flesh specifically, since that's the case study here.
Sarah: 10:49
Sure.
Brad: 10:49
There are a couple of features that seem designed to fix the exact problems doctors hate about the old system.
Sarah: 10:55
There are. And remember, Bill Flesh isn't some small player. The Source notes over 60,000 providers are in this ecosystem. That's a huge number.
Brad: 11:05
One of the biggest differentiators they highlight is the money flow. We talked about how traditional agencies hold the money.
Sarah: 11:11
The we'll pay you when we get around to it model.
Brad: 11:14
Yeah.
Sarah: 11:14
That's maybe the biggest operational difference with BillFlash. The source says collected payments are deposited directly into the user's bank account.
Brad: 11:23
The provider gets paid first.
Sarah: 11:24
First.
Brad: 11:24
That seems like such a simple shift, but for a small business, that's a game changer. It removes that whole float game the agencies were playing.
Sarah: 11:32
It absolutely does. The agency isn't acting like a bank holding your funds. And. And then there's the staff competency. We talked about empathy, but the source gets specific. Like, well, their specialists are licensed in all 50 states. They get ongoing compliance training. But get this. 75% of their specialists are bilingual.
Brad: 11:53
75%. Wow. That's huge. Why is that so critical?
Sarah: 11:58
Think about the stress of a medical bill. It's confusing the codes, the insurance jargon. Now imagine trying to navigate that in a language you aren't fully comfortable in.
Brad: 12:08
You're scared. You're confused and you can't understand the person on the phone, so you just hang up.
Sarah: 12:11
Exactly. By having bilingual specialists, they're removing that barrier. It doesn't just help the patient understand, it actually increases the likelihood of the bill getting paid because the confusion is gone.
Brad: 12:21
It's about meeting people where they are.
Sarah: 12:23
It is.
Brad: 12:24
And speaking of that, can we talk about plan pay? Because this addresses the reality that sometimes people just don't have the full amount.
Sarah: 12:30
This is the flexibility piece. The old model is often pay the full $500 now or else.
Brad: 12:35
Right.
Sarah: 12:35
Plan pay is a feature in the system that allows for pre authorized payment plans. If someone has a valid reason, it can set up installments. Can you do $50 a month?
Brad: 12:45
Which again maintains the relationship. It's the difference between you're a deadbeat and we know this is a lot. Let's break it down and logically.
Sarah: 12:53
Getting $50 a month for 10 months is infinitely better for a practice than getting $0 because the patient was intimidated and just stopped answering the phone.
Brad: 13:01
So we have this new tech, we have the features. Does it actually matter in the real world? The source had some survey data on this.
Sarah: 13:08
Yes. They surveyed providers and found that 65% of them specifically said they needed help with medical debt collection.
Brad: 13:15
That's nearly 2/3 of doctors basically saying, we are drowning in this.
Sarah: 13:20
It shows the problem is widespread. This isn't a niche issue. This is Main street medicine. And the testimonial from a billing service pro in the text really drives it home.
Brad: 13:30
They call themselves a customer for life. That is high praise for billing software. Usually people hate billing software.
Sarah: 13:37
I know it's like saying you're a fan for life of the dmv. But this person noted increased revenue, decreased statement costs. When you saw the headache that big, you earn loyalty.
Brad: 13:47
So if we zoom out, what does this tell us about the future? Because this trend of rising patient responsibility isn't going away.
Sarah: 13:57
No, the so what here is really about that shifting landscape? As we said at the top, deductibles are going up out of pocket, costs are rising, the burden is shifting to the patient.
Brad: 14:08
Which means there are going to be more and more bills to collect.
Sarah: 14:10
Exactly. And the argument the source is making is that the future of medical finance can't be about being more aggressive. You can't just bully everyone. It's unsustainable. The future has to be about being more integrated.
Brad: 14:21
It's about scalability too.
Sarah: 14:23
That's the key. Whether you have 100 patients or 10,000, all automation handles the load. You can't scale a manual process where you're filling out paper forms for every single unpaid bill. You can scale a system that auto identifies and engages based on rules you set.
Brad: 14:38
It really feels like we're moving from an analog world to a digital one. But surprisingly, the digital one feels more human.
Sarah: 14:44
That is a profound observation. We often think of automation as cold, but in this case, automation allows for consistency. It removes the error, and by integrating it, it keeps the provider in the driver's suit.
Brad: 14:57
It uses the robot to handle the math so the human can handle the relationship Perfectly Said. So to recap, we started with a $4.8 trillion healthcare price tag and the realization that a lot of that comes from us, the patients.
Sarah: 15:13
And we looked at the old way, the black box, the loss of control, the aggressive phone calls that just ruin relationships.
Brad: 15:19
And we contrasted that with this new way, integrating services like BillFlash, where it's all built into the software. The doctor gets the final say and the money goes straight to their bank account.
Sarah: 15:29
And ultimately, it's about reframing the whole thing. It's not a hostile, separate process. It should be part of the patient care cycle.
Brad: 15:36
That is the big takeaway for me. If a doctor treats your broken leg with care, but then treats your bank account with hostility, the trust is broken.
Sarah: 15:44
It is.
Brad: 15:45
The source suggests that by treating billing as part of the care, by making it respectful and transparent, doctors get paid faster without losing their patients trust.
Sarah: 15:55
It's a win win. The provider stays financially viable and the patient retains their dignity.
Brad: 16:01
So here's the question I want to leave you with. Today. We've seen how technology can make something as hated as debt collection more humane by giving providers visibility and control. So if we can fix debt collection, what other unpleasant parts of healthcare administration could be fixed with that same principle? More control, more visibility.
Sarah: 16:22
That's a fascinating question.
Brad: 16:24
Is it scheduling? Is it the nightmare of insurance prior authorizations? If we apply this same integrated philosophy, transparent rule based, human, reviewed elsewhere, how much better could the healthcare experience be?
Sarah: 16:37
I think the ceiling on that is very, very high. If you can humanize the bill, you can probably humanize the rest of the bureaucracy too.
Brad: 16:44
Something to mull over the next time you're in a waiting room filling out a clipboard. Thanks for diving in with us today.
Sarah: 16:48
See you next time.
Narrator: 16:50
Thanks for tuning into the Billing Blueprint podcast. For more insights or to dive deeper dive deeper into today's topics. Head over to billflash.com. Don't forget to subscribe and we'll catch you next week with more strategies to keep your practice running smoothly and getting paid faster
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