Back in the good old days patients’ out-of-pocket responsibility for healthcare costs was negligible. Remember the $5 office visit co-pay, just as an example?
As a result hospitals and physician offices set their billing and collection systems up to work with health plans and government payers. Consumer billing was an afterthought, bills were hard to understand and to reconcile with insurance company statements, and collection rates were low. No one really cared if the patient paid or not.