I have a friend who worked with the billing system at a major hospital in Florida. Beyond the obvious practice of providers billing for much more than the actual cost of service, to maximize insurance reimbursement after rounds of "negotiations" after each client, there is something more insidious going on as an industry.

My friend (anecdote, sure, but something like this will never be written in policy, so I can't cite) said "we were told NOT to send anything to collections unless the amount was "very high." He was then told that the hospital was made whole with every insurance reimbursement, and that any amount "owed" from clients aren't actually a big deal- if they pay it, great, if not, it's alright. Furthermore, the impetus for not sending to collections was because there is a certain threshold where if the populous found out about their many shady billing practices, they would be exposed, and would rather not deal with that.

I'd like to say that I am surprised nothing has been done about this, but I'm honestly not surprised because the incentives and economics are there in your face.