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[Shikima]

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I'd like to get a sense of what others are doing when patients do not make payments and carry an overdue balance? How do you handle this in addition to offering payment plans? What risks are there in cutting off service for non-payment or until the balance is paid? What are the legal considerations?

So many questions, so little information....

 

[F0nzie]

The first thing I do is I accept every business has losses and that the worst that can happen is the patient does not pay. The second thing I do is I see/bridge them until they find a follow up with another provider they can afford to see. Sometimes the process is easy and other times it can take several months. I do not offer payment plans. If they owe money and cannot or will not pay I let it go and wipe out the balances.


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[nexus73]

No collections?

 

[Shikima]

No collections?

Collections is used.

I'm attempting to garner further ideas how balances are taken care of as OH doesn't pay for itself, and if, what strategies are employed including termination?

 

[F0nzie]

Collections is used.

I'm attempting to garner further ideas how balances are taken care of as OH doesn't pay for itself, and if, what strategies are employed including termination?

A PCP buddy of mine uses collections which makes sense in a high volume insurance setting. He sends 2 closure letters: one first class and the other by certified mail. Every patient that does not pay creates a debt for the practice and the number of patients who do not pay is staggering... I think he mentioned something on the order of 50% having outstanding balances? I cannot imagine how he takes care of that.


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[splik]

What risks are there in cutting off service for non-payment or until the balance is paid? What are the legal considerations?

you should consult with your state medical board to see if there are state specific rules regarding this. In general, the main liability would be patient abandonment. So you would want to establish that there was a pattern of non-payment (i.e. several unpaid bills or failure to clear debts despite several attempts to do so, including offering payment plans or offering patient opportunity to provide evidence of financial hardship), with a prior warning about termination, and that you have a policy about this that patients are aware of when they establish care. There may be some differences by locale but in general, you should provide enough time for a patient to find a new psychiatrist (30 days is typical) as well as 30 days worth of medication. You are not responsible for finding them a new a psychiatrist.

If there was a bad outcome (for example patient suicide), a causal nexus between termination and the outcome would have to be established. as you presumably would do anyway, you would want to complete and document a mental status examination and risk assessment at the time of termination. you would not want to terminate a patient who was acutely suicidal of course. however if a patient was making a contingent suicide threat upon termination, that should not be a reason to not terminate the patient but for evaluation in the emergency room.

prevention is better than cure - the best way to avoid this is to screen patients as best as you can in the first place, have a policy in place regarding non-payment and termination, and keep patient credit card details on file

 

[milesed]

Anyone do what my dentist does? You pay in full as you check out at each visit, then they send you a check for what insurance covered.

 

[Shikima]

A PCP buddy of mine uses collections which makes sense in a high volume insurance setting. He sends 2 closure letters: one first class and the other by certified mail. Every patient that does not pay creates a debt for the practice and the number of patients who do not pay is staggering... I think he mentioned something on the order of 50% having outstanding balances? I cannot imagine how he takes care of that.


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We are hospital affiliated and the PCPs drive the medical economy and rely upon specialists to help. To that extent and the environment where the practice is located, a lot of practices carry unpaid balances. I know for our clinic it's in the 10's of thousands and looking for meaningful ways to reduce this as OH won't pay for itself.

 

[TexasPhysician]

I collect all payment up front.

I provide patients with an extra month of medication between planned appointments, and I inform them all that I don't give further refills without follow-up. If a patient doesn't return given an extra 1+ month, they are non-compliant with treatment recommendations. They were also already given an extra 30+ days to find alternate care.

I obviously have some more or less strict guidelines based on certain medications and circumstances, but this is a rough idea.

 

[F0nzie]

I collect all payment up front.

I provide patients with an extra month of medication between planned appointments, and I inform them all that I don't give further refills without follow-up. If a patient doesn't return given an extra 1+ month, they are non-compliant with treatment recommendations. They were also already given an extra 30+ days to find alternate care.

I obviously have some more or less strict guidelines based on certain medications and circumstances, but this is a rough idea.

I have thought about payment upfront many times but decided not to. I charge after seeing the patient because I feel the relationship should be based on trust and mutual respect. I have had new patients that did not agree with my recommendations who walk out without paying. I am ok with that. If they feel they have won by leaving my office without paying me for my time I'm ok with that too. At the end of the day, I go to sleep without anxiety, worries, or guilt.


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[TexasPhysician]

I have thought about payment upfront many times but decided not to. I charge after seeing the patient because I feel the relationship should be based on trust and mutual respect. I have had new patients that did not agree with my recommendations who walk out without paying. At the end of the day, I go to sleep without anxiety, worries, or guilt.


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I told the same thing to the people at Target, but they refused to let me utilize the underwear before paying. Can you explain this to them?

The great thing about private practice is doing things however you want. If you prefer your way, I think that is excellent. The first paragraph was all in fun.

 

[birchswing]

I have thought about payment upfront many times but decided not to. I charge after seeing the patient because I feel the relationship should be based on trust and mutual respect. I have had new patients that did not agree with my recommendations who walk out without paying. I am ok with that. If they feel they have won by leaving my office without paying me for my time I'm ok with that too. At the end of the day, I go to sleep without anxiety, worries, or guilt.


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The strange thing is that if you read advice columns in various newspapers and magazines they recommend "trying a doctor" with a consultation first to see if it's a good fit--usually in the context of saying that patients need a good relationship with the doctor, etc. In reality, I've never seen a doctor offer this service separately from a regular intake, which is the longest and most expensive. But I wonder if some people think of the first appointment as a consult and thus assume it's free, when in reality for the psychiatrist it's the big initial push of treatment--like a rocket taking off. You go in on the first one, evaluate history, symptoms, and chart a course. After that it's tweaking. In my experience you never really get an appointment like the first one again. I don't mind paying for a consultation as an intake appointment even if I end up not working with that doctor. In fact, I did that with one particular psychiatrist and it didn't work out for the reason that his next follow-up wasn't available for three months out, which was not frequent enough for me. I still paid the intake fee--although in his case I'm not sure he should have been taking new patients.

 

[nexus73]

The strange thing is that if you read advice columns in various newspapers and magazines they recommend "trying a doctor" with a consultation first to see if it's a good fit--usually in the context of saying that patients need a good relationship with the doctor, etc. In reality, I've never seen a doctor offer this service separately from a regular intake, which is the longest and most expensive. But I wonder if some people think of the first appointment as a consult and thus assume it's free, when in reality for the psychiatrist it's the big initial push of treatment--like a rocket taking off. You go in on the first one, evaluate history, symptoms, and chart a course. After that it's tweaking. In my experience you never really get an appointment like the first one again. I don't mind paying for a consultation as an intake appointment even if I end up not working with that doctor. In fact, I did that with one particular psychiatrist and it didn't work out for the reason that his next follow-up wasn't available for three months out, which was not frequent enough for me. I still paid the intake fee--although in his case I'm not sure he should have been taking new patients.

I think this is driven by how insurance reimburses. First visit is the diagnostic assessment, all subsequent visits are short duration follow ups.

 

[Leo Aquarius]

When I set up my practice I will demand payment up front but will make it very easy for them to pay by accepting paypal and credit cards, at the front office or online using a portal. No excuses!