Pat Silver paints two possible scenarios for collecting unpaid medical bills.
In scenario one, a big guy named Bruno has tracked you down and knocks on your door, demanding payment. You have no insurance, and you tell him you can't pay it. You soon change your address.
In scenario two, a social worker comes to the door and explains how you might qualify for state or federal health insurance programs, Medi-Cal or Medicare. The social worker helps you find your birth certificate and other needed records, helps fill out the 15-page form and arranges transportation to the required in-person interview needed to qualify for Medi-Cal.
Silver's company, Silver Hospital Services in Orange, once used the first collection method. When she switched to the second, the number of cases she was able to collect on improved from about 50% to 91%.
That's a nice percentage from the hospital's perspective. One of Silver's clients, Huntington Memorial Hospital in Pasadena, began handing over cases to her about seven months ago. In that time, Huntington Memorial has begun receiving Medi-Cal payments on $433,300 worth of bills. It paid $11,597 to Silver for that service. Silver charges $60 a day, or a $240 minimum, for each case.
Without Silver, the $433,300 "would have been written off to charity," said Pat Watson, credit manager for Huntington Memorial.
Watson is also pleased with the image Silver's service presents on behalf of her hospital.
"They've got a lot of compassion," Watson said. "It's not just money, money, money."
In the past, when she could, Watson drove out to patients' homes herself after work, even though that was not part of her job. She didn't know that anything like Silver's company existed. Of course, there are more standard collection agencies. What makes Silver's company unusual is that she hires trained social workers instead of collection agents.
One other Orange County company, Syndicated Office Systems in Orange, has a similar employment policy: it hires former welfare workers.
Silver said the idea of hiring social workers came to her by accident. She placed a "help wanted" ad describing the job's duties and a social worker applied.
"That's when I realized there were people pretty specifically trained to do this work," Silver said. "And it's nice that they come with a concept of this being a profession, not a job. Their orientation is to families; they're more proactive."
Silver employs seven people and works with four hospitals--Huntington Memorial, Loma Linda University Medical Center, Loma Linda Community Hospital and Pioneer Hospital in Artesia.
The Medi-Cal qualification process is difficult even if you are an adult, are fluent in English and have use of a car. Take away any one of those elements, and the difficulty increases.
The patients whose names end up on Silver's desk have almost always entered the health care system through the emergency room. Some are Mexican citizens who cross the border for health care, then go home. Silver says she can trace them through family members here, usually.
Other patients are young, unwed mothers. Or they have AIDS and have maxxed out their medical insurance. Some have pre-existing medical conditions, and private insurance companies will not insure them. Some are under arrest when they enter thehospital and go to jail after they aredischarged.
Sometimes they don't know that they can qualify for government assistance. Other times, as in the case of the young mothers or the dying AIDS patients, paying the doctor's bill is low on their list of priorities.
Silver's husband, who was a private investigator, started the company with a colleague in 1976. Silver handled the office paperwork. They believed that their training in finding people would be a valuable service, and they worked for Long Beach Memorial Medical Center exclusively for years.
Silver's husband died in 1984, the colleague left, and she took over the business. Last year, in 1991, she handled 207 accounts and had revenue of $290,000. In January, she hired a director of account development, Joanne LaPointe, to increase the number of hospitals they serve.
"It's been easy to find hospitals that think the way we do about taking the humane approach," said LaPointe, whose background is in sales and marketing to hospitals. "The trick is locating the right person and getting past the secretary."