In many cases, medical billing companies will start by sending out a bill to a patient, with a date by which it must be satisfied. If it is not paid by that date, the company will have to send a reminder, and then let the patient know about any late fees or collection activity that may have to be taken if it is late. If the notice is still ignored, then the company may have to enforce the policies, meaning that the bill could be sent to collections. While this may not be the best outcome, it will ensure you get at least some of your money. This is better than letting the unpaid bills pile up once patients realize there are no consequences. The result is that medical billing companies may end up paying for themselves with the bills that they ensure are finally satisfied. So, consider that before you assume you cannot afford to outsource the work.