ROCHESTER, Minn. – In filing 179 court cases against patients from March of 2020 to March of 2021 – 30 in June alone – Rochester-based Mayo Clinic was more active in the suing of patients during the pandemic than previously understood.

Mayo says it sues only a small percentage of those it treats, has not acted on any judgments since May of 2020 and actively helps those patients willing to tap assistance.

But it was far from alone in the practice of serving papers on Minnesotans for using medical care, or even atop the list of Minnesota providers in their use of the courts to chase bills during the first 12 months of COVID-19.

Public records reviewed by Forum News Service show that suing to collect on medical bills was commonplace in Minnesota during the pandemic, a lever utilized by health systems large and small to highly varying levels.

Via a subsidiary known as Accounts Receivable Services LLC d/b/a Reliance Recoveries, Twin Cities-based Allina Health filed 329 court actions against patients during the pandemic.

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Most of those actions occurred in early 2020, however, then tapered off completely as the provider ceased all filings against patients between April and December.

A representative from Allina said the network continues "to significantly limit the number of accounts that are being initiated through the court system," and that less than 5% of its unpaid accounts end up in judgments.

With over 2,100 patients sued for medical debts between March of 2020 and 2021, Minneapolis-based Fairview Health Services tapped the courts to a degree appearing to dwarf that of some competitors.

Fairview counters that as a percentage of revenue, its actions are in line with other health systems, and that it provided $38 million in charity care last year.

"As a non-profit organization, Fairview works closely with patients to ensure payment without undue financial hardship," said a Fairview spokesperson in a statement.

"This collaboration includes assisting patients with charity care ... Medicaid applications, (and) payment arrangements at any time, taking into account pandemic-related hardships and ability to pay."

"This intensive and patient-centered process results in a very small amount – less than 1% – of our clinical bills ending in litigation," the statement continued. "We do not file lawsuits against patients with no or insufficient assets to pay their bills."

"Medical payment collections are, unfortunately, a part of the way the health care financing system has been set up in the United States," the statement concluded, adding that "collection of funds from those with the ability to pay serves the community by keeping the cost of care lower for all patients."

Rising deductibles: 'We're all left holding the bag'

Other providers blamed rising deductibles for lawsuit activity as well.

"Medical debt has been on the rise for several years across the country," says Rochester-based Olmsted Medical Center Chief Financial Officer Kevin Higgins in a statement. "It has been accelerated by the expansion of high-deductible health plans which has shifted a higher portion of the responsibility for the medical payment to the patient."

According to the Forum News Service analysis, OMC filed 172 court actions seeking payment from patients between March of 2020 and 2021, nearly as many as its much larger neighbor, Mayo Clinic.

"We have worked hard to be supportive to our patients during a very difficult and unique time," Higgins said, noting that OMC placed a four-month hold on payment requirements for patients repayment plans during the pandemic, ceasing all legal collections between March and August of 2020.

Melanie Wilson, Vice President for Revienue Services, Essentia Health
Melanie Wilson, Vice President for Revienue Services, Essentia Health

Higgins added patient balances can receive full or partial write-offs at OMC if a household falls below 300% of the federal poverty line, an eligibility threshold that stops at $40,000 annually for single persons, $80,000 for a family of four.

"It is a very unfortunate environment as these deductibles continue to rise," said Melanie Wilson, vice president for revenue services for Duluth-based Essentia Health, which filed 213 lawsuits during the pandemic. "We will continue to find ways to help people find programs."

Wilson cited a prolonged effort within Essentia to sign up qualifying patients for aid before or after services, citing no-interest, six-month payment plans or five-year loans.

"We actually pay a vendor from our pocket to help our patients get enrolled in Medicaid and other government programs," she said.

Essentia says it attempts to engage with patients for 270 days before sending a balance to collections, and forgives balances for individuals making less than $26,000 or $53,000 for a family of 4.

Essentia writes off that debt, she said, even if qualifying patients haven't answered their efforts to make contact. That said, Wilson believes patients have many reasons for not responding to opportunities for repayment.

"I can't speak for all health care organizations, but we do recognize that our customers are people who don't always elect to utilize our services," she says. "Maybe they are caught off guard, or they are not prepared."

"As these insurance companies go out and sell these plans to patients we're all left holding the bag," she says. "Patients are left with huge deductibles that they can't pay, so they end up with bad debt."

"We're paying more for premiums, our deductibles are rising, and as a health care organization our reimbursement is going down. We will eventually reach a tipping point, I believe. We have to have our insurances come to the table and offer a different solution for us ... to offer a good form of coverage for our patients."