Writing off charges

[militarymd]

So when I take my bike to the mechanic, I get a pretty big bill...which I pay. When the plumber comes to my house, I pay the bill. When the guy comes to work on my sprinklers, I pay the bill.....

Why is it that when I send a bill to patients, they send back notes asking me to "write off the charges"?

Do these patients ask their mechanics, plumbers, and other service providers to waive the fees? Or do they just ask their doctors?

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[Gimlet]

So when I take my bike to the mechanic, I get a pretty big bill...which I pay. When the plumber comes to my house, I pay the bill. When the guy comes to work on my sprinklers, I pay the bill.....

Why is it that when I send a bill to patients, they send back notes asking me to "write off the charges"?

Do these patients ask their mechanics, plumbers, and other service providers to waive the fees? Or do they just ask their doctors?

Interesting topic, Mil. To start off with, I'd be curious to know if doctors in other specialties get similar requests, or if this phenomenon is specific to (or amplified in) anesthesiology.
For example, I doubt many patients write to their surgeons and ask them to "write off the charges." Maybe it says something about the way lay-people view anesthesia.

 

[militarymd]

Interesting topic, Mil. I'd be curious to know if doctors in other specialties get similar requests, or if this phenomenon is specific to (or amplified in) anesthesiology. For example, I doubt many patients write to their surgeons and ask them to "write off the charges." Maybe it says something about the way lay-people view anesthesia.

Nope, happens to surgeons too.

 

[jetproppilot]

So when I take my bike to the mechanic, I get a pretty big bill...which I pay. When the plumber comes to my house, I pay the bill. When the guy comes to work on my sprinklers, I pay the bill.....

Why is it that when I send a bill to patients, they send back notes asking me to "write off the charges"?

Do these patients ask their mechanics, plumbers, and other service providers to waive the fees? Or do they just ask their doctors?

Nope, they just ask their doctors.

What other job do you get out of bed at 2 am to perform lifesaving measures on someone who is dying from a GSW/stab wound/MVA on a Saturday night, and usually for free since Joe Dirt aint got no insurance?

And for you budding grasshoppas out there, losses from non-collection are not tax deductible. So in other words if you dont collect it, you eat it.

My buddy who is a lineman for the electrical company gets time-and-a-half after hours and on weekends. Double time for holidays.

Best thing you can do, Mil, is arm tourself with a cuppla girls who have a PhD in The-Psychology-of-Collections, a Masters in Collecting-Money-From-Denying-Insurance-Companies, put them on a salary with-bonus-incentive in your billing office, and lett'em rip.

 

[jetproppilot]

Nope, they just ask their doctors.

What other job do you get out of bed at 2 am to perform lifesaving measures on someone who is dying from a GSW/stab wound/MVA on a Saturday night, and usually for free since Joe Dirt aint got no insurance?

And for you budding grasshoppas out there, losses from non-collection are not tax deductible. So in other words if you dont collect it, you eat it.

My buddy who is a lineman for the electrical company gets time-and-a-half after hours and on weekends. Double time for holidays.

Best thing you can do, Mil, is arm tourself with a cuppla girls who have a PhD in The-Psychology-of-Collections, a Masters in Collecting-Money-From-Denying-Insurance-Companies, put them on a salary with-bonus-incentive in your billing office, and lett'em rip.

Sorry, arm yourself with...

 

[jetproppilot]

Interesting topic, Mil. To start off with, I'd be curious to know if doctors in other specialties get similar requests, or if this phenomenon is specific to (or amplified in) anesthesiology.
For example, I doubt many patients write to their surgeons and ask them to "write off the charges." Maybe it says something about the way lay-people view anesthesia.

Happens in EVERY specialty, Andy.

 

[bogatyr]

What do the mechanics and plumbers do with their deadbeat accounts? I know the guy remodeling your kitchen can in certain circumstances take out a lien on your property.

 

[Gimlet]

My mom is a lawyer and owns her own practice. She uses a collection agency for her delinquent accounts...I've never been sure how they work, but in my head it involves large men armed with 2x4's showing up at your house late at night.

 

[militarymd]

Our collection agency is very good, but I get all these letters (sob stories), asking me to write off bills.

It's always hard to decide who to write off and who to send to the collection agency.....

and we can't put a lien on their house....it would be great if we could.

 

[militarymd]

I'm also pretty sure that delinquent medical bills do not hurt your credit score.

 

[Gimlet]

Our collection agency is very good, but I get all these letters (sob stories), asking me to write off bills.

It's always hard to decide who to write off and who to send to the collection agency.....

and we can't put a lien on their house....it would be great if we could.

What criteria do you use to decide who to write off? Would it be unreasonable for your practice to institute a "no write-offs" policy, or is that considered bad form? I think that to a certain extent professions like doctors and lawyers are expected to do some pro bono work, but the question is how much, and for whom.

 

[sdn1977]

Just an interesting story of writing off stuff from a long time ago-18 years ago, my husband had to have a brain tumor removed. When the bill came, we paid our part, but the insurance company dragged their feet. I finally called and they asked me to call the surgeons & anesthesiologists (he had a few..)to ask for a professional discount - because...we were all "in the same business" - their words! Now...how neurosurgery& anesthesiology is the "same business" as dentistry & pharmacy was beyond me then as it is now. I told them I thought $6000 (the surgeon's fee 18 yrs ago) was a very small price to have to work for 6 hours looking through a microscope in a hole in my husband's head the size of a quarter! After I calmed down, I suggested perhaps our lawyer could explain why we wouldn't feel comfortable calling for a discount.....the bill was finally paid! I guess they negotiate because they can.

 

[jetproppilot]

I'm also pretty sure that delinquent medical bills do not hurt your credit score.

Not true. Once reported to a collection agency, if the bill is not paid it will be reported as a delinquent account and will affect their credit score.

 

[bullard]

That's a great story. And you're right -- you don't get what you deserve; you get what you negotiate for. If we were in that particular line of work *shudder* we'd be doing the same thing.

the bill was finally paid! I guess they negotiate because they can.

 

[UTSouthwestern]

Always interesting when this happens. For instance, I recently had a patient who was paying for heart surgery out of pocket. I called him and discussed the details of the anesthetic plan and he began negotiating with me on the need for various procedures.

After 15 minutes of what seemed like negotiating more than a pre op interview, I wanted to say, "Look, do you want a Cadillac anesthetic or a Jalopy anesthetic?"

Always make sure you have a good collection agency. Everyone will try to find a reason to want you to write off charges, but the bottom line is that you are providing life sustaining services and absorbing possibly life altering liability.

 

[MD Dreams]

Not true. Once reported to a collection agency, if the bill is not paid it will be reported as a delinquent account and will affect their credit score.

I used to be a bill collector in my past life . A person's credit report will show that they have delinquent medical bills, but the actual credit score is not affected.

 

[BubbleHead]

I've been reading this forum for several months now and I appreciate MilitaryMD and JetPropPilot's posts... But, this is over the line and I feel I need to say something.

I've been in one of the top 130 or so US Allopathic Medical Schools for almost 4 yrs now and attended quite a few of the classes offered, but never do I remember any lecture listed addressing collecting money from patients or problems with collecting money. And I mean, I would have taken notes on that topic. So, I don't know what kind of gag you two are up to, but I'm not falling for it.

If collections were part of being a doctor, I'm certain my medical school would have prepared me for it. So, let's move on and talk about matching some more.

Thanks

PS - Has anyone heard rumors of a new branch of medicine getting started recently? I've heard people discussing it, it's called ICD-9 or something like that.

Thanks again

 

[bullard]

That's really neat. Were you guys talking about different antiemetics? Or did he want you to do the case without central access?

Always interesting when this happens. For instance, I recently had a patient who was paying for heart surgery out of pocket. I called him and discussed the details of the anesthetic plan and he began negotiating with me on the need for various procedures.

After of 15 minutes of what seemed like negotiating more than a pre op interview, I wanted to say, "Look, do you want a Cadillac anesthetic or a Jalopy anesthetic?"

 

[militarymd]

I've been reading this forum for several months now and I appreciate MilitaryMD and JetPropPilot's posts... But, this is over the line and I feel I need to say something.

I've been in one of the top 130 or so US Allopathic Medical Schools for almost 4 yrs now and attended quite a few of the classes offered, but never do I remember any lecture listed addressing collecting money from patients or problems with collecting money. And I mean, I would have taken notes on that topic. So, I don't know what kind of gag you two are up to, but I'm not falling for it.

If collections were part of being a doctor, I'm certain my medical school would have prepared me for it. So, let's move on and talk about matching some more.

Thanks

PS - Has anyone heard rumors of a new branch of medicine getting started recently? I've heard people discussing it, it's called ICD-9 or something like that.

Thanks again

You can practice medicine without a collection agency..... your practice will last as long as the due dates placed your bills by the collection agencies that will be coming after you.

 

[MD Dreams]

I've been reading this forum for several months now and I appreciate MilitaryMD and JetPropPilot's posts... But, this is over the line and I feel I need to say something.

I've been in one of the top 130 or so US Allopathic Medical Schools for almost 4 yrs now and attended quite a few of the classes offered, but never do I remember any lecture listed addressing collecting money from patients or problems with collecting money. And I mean, I would have taken notes on that topic. So, I don't know what kind of gag you two are up to, but I'm not falling for it.

If collections were part of being a doctor, I'm certain my medical school would have prepared me for it. So, let's move on and talk about matching some more.

Thanks

PS - Has anyone heard rumors of a new branch of medicine getting started recently? I've heard people discussing it, it's called ICD-9 or something like that.

Thanks again

I can't tell if your being sarcastic or not?

Anyways, theres a lot of things they don't teach you in medical school. Example, drawing blood, starting IV's. But as a med student, resident, doctor, you will need to know this. The financial side of practicing medicine is another thing you'll need to learn on your own.

The truth is that many people start out having altruistic intentions. But when they see the real world, they realize that there are so many people out there waiting to screw you over, that it becomes very difficult to sort out the people who really need help from those who are abusing the system. After a while, doctors become jaded and bitter, myself included. That's when you have to decide to draw the line and treat everyone with the same standards, even if it means being harsh. It's sad, but true!

 

[jetproppilot]

I've been reading this forum for several months now and I appreciate MilitaryMD and JetPropPilot's posts... But, this is over the line and I feel I need to say something.

I've been in one of the top 130 or so US Allopathic Medical Schools for almost 4 yrs now and attended quite a few of the classes offered, but never do I remember any lecture listed addressing collecting money from patients or problems with collecting money. And I mean, I would have taken notes on that topic. So, I don't know what kind of gag you two are up to, but I'm not falling for it.

If collections were part of being a doctor, I'm certain my medical school would have prepared me for it. So, let's move on and talk about matching some more.

Thanks

PS - Has anyone heard rumors of a new branch of medicine getting started recently? I've heard people discussing it, it's called ICD-9 or something like that.

Thanks again

Sorry, but medicine is a business. You provide a service, and expect to get paid. Collection people in your office are part of the gig. In my previous gig we had one person whose SOLE job was to address past-due accounts.
Not just private practice either...do you think the universities who employ academic physicians just forget about unpaid medical bills?

Peculiar post...

Top 130 med school?? How many are there?

And in med school you "attended quite a few of the classes offered?"

Med school isnt like college. You dont pick your classes.

 

[Gimlet]

I think Bubblehead was laying the sarcasm on pretty thick in that post.

 

[jetproppilot]

I think Bubblehead was laying the sarcasm on pretty thick in that post.

Yeah, youre right Dude. Got me, Ashton. I've been punked.

 

[bullard]

That was a very good sarcastic post. Medical school curricula need a major overhaul.

 

[BubbleHead]

I can't tell if your being sarcastic or not?

Anyways, theres a lot of things they don't teach you in medical school. Example, drawing blood, starting IV's. But as a med student, resident, doctor, you will need to know this. The financial side of practicing medicine is another thing you'll need to learn on your own.

The truth is that many people start out having altruistic intentions. But when they see the real world, they realize that there are so many people out there waiting to screw you over, that it becomes very difficult to sort out the people who really need help from those who are abusing the system. After a while, doctors become jaded and bitter, myself included. That's when you have to decide to draw the line and treat everyone with the same standards, even if it means being harsh. It's sad, but true!

Sorry,

That wasn't fair, I don't post much and you guys/gals don't know me. Please reread my above post and add-in HEAVY, HEAVY SARCASM. Was just trying to be funny, it doesn't always work, but I don't stop trying.

- I think there are about 130 US Allopathic Schools
- I meant "lectures" when I said classes, ours are recorded on MP3 files, so there are several "Pheonix University" type students learning from a distance...
- My school did teach us IVs and Blood Drawing in the Principles of Clinical Medicine Course, practiced on each other and our Preceptors.

 

[jetproppilot]

Sorry,

That wasn't fair, I don't post much and you guys/gals don't know me. Please reread my above post and add-in HEAVY, HEAVY SARCASM. Was just trying to be funny, it doesn't always work, but I don't stop trying.

- I think there are about 130 US Allopathic Schools
- I meant "lectures" when I said classes, ours are recorded on MP3 files, so there are several "Pheonix University" type students learning from a distance...
- My school did teach us IVs and Blood Drawing in the Principles of Clinical Medicine Course, practiced on each other and our Preceptors.

Got me, dude. Got me. I've been punked. Turn off the camera.

 

[militarymd]

 

[jetproppilot]

HAHAHAHAHAHHAHAHAHAHHAHAHAHAHAHHAHAHAHAHAHAHAHAHHAHAHA

I said shut off the f ucking camera!!!!!

CUT!!!!! CUT!!!!!!!!

 

[ThinkFast007]

back to the OP's post.

I considered myself pretty well informed about anesthesiology/medicine. BUT this topic totally caught me off guard. FOr most of us med students we arent exposed to much private practice. Most universities are located in 'ghetto-er' areas where the population is more indigent and most ppl are on medicare/have no ins to begin with..i figure docs at universities just suck it up.

But i guess in private practice you really cant afford to 'suck it up'. Thats friggin unreal guys. UT, JET, MMD did you guys ever try to get patients to pay half or so upfront? Knowing how much anesthestics for the average let's say Lap Chole costs, couldnt you be like look the total is going to be $5000 (i have no idea how they are)...but we want $2500 now, then the rest later..ie post op? ie. i know you cant do this in EMERGENCY cases, etc

I agree w/ you guys that you all have bills and stuff to pay and you are providing a service and should be rightfully repaid. I think that docs get such a bad rep about being so 'sticklerish' and wanting money...but hey like someone said on here you have to be or else ppl will ride you.

sooooo guys anything else about anesthesiology and the practice in general where you can get screwed over?

 

[UTSouthwestern]

back to the OP's post.

I considered myself pretty well informed about anesthesiology/medicine. BUT this topic totally caught me off guard. FOr most of us med students we arent exposed to much private practice. Most universities are located in 'ghetto-er' areas where the population is more indigent and most ppl are on medicare/have no ins to begin with..i figure docs at universities just suck it up.

But i guess in private practice you really cant afford to 'suck it up'. Thats friggin unreal guys. UT, JET, MMD did you guys ever try to get patients to pay half or so upfront? Knowing how much anesthestics for the average let's say Lap Chole costs, couldnt you be like look the total is going to be $5000 (i have no idea how they are)...but we want $2500 now, then the rest later..ie post op?

I agree w/ you guys that you all have bills and stuff to pay and you are providing a service and should be rightfully repaid. I think that docs get such a bad rep about being so 'sticklerish' and wanting money...but hey like someone said on here you have to be or else ppl will ride you.

sooooo guys anything else about anesthesiology and the practice in general where you can get screwed over?

There are some situations where you can get the payment up front and it's a much sweeter deal to know your services are paid for before the anesthetic is given. I always look for those opportunities for my group.

 

[f_w]

A patient asking to get a write-off on a charge once they receive the bill is a deadbeat. If politically feasible, this is the type of account I have no qualms to send to collections.

It is different if a patient asks for payment arrangements e.g. to pay installments on the bill. Most practices I know of will accept installments and once the installments are somewhere around the medicare rate, write off the rest.

A different animal alltogether is a request for charity care up front, before the service is delivered. Nothing wrong with providing some pro-bono services, and being voluntarily charitable is different from getting screwed out of your rightful fees by a deadbeat.

 

[ThinkFast007]

everyone on here is writing about collections agenices etc. I agree, using them would probably be the most beneficial. BUT, i would assume they have a fee and arent working for charity themselves. what's the fee like?

i agree w/ jet it's probably better to hire drug rep gals to be your secretaries to do your collections....if thats cheaper

 

[toofache32]

Isn't it considered insurance fraud to accept insurance payment by not require the patient to pay their part?

 

[f_w]

BUT, i would assume they have a fee and arent working for charity themselves. what's the fee like?

You 'sell' the right to collect the debt to them. They will look at the claim, make an educated guess on how likely it is that they can collect the claim and pay you pennies to the $$.

 

[rugtrousers]

I go to a med school where the main hospital has been demonized by the community for using standard (but very aggressive) collection techniques to recoup unpaid debts. It seems like a damned if you do (you're attacking poor people) damned if you don't (risk going bankrupt) proposition.

 

[f_w]

I go to a med school where the main hospital has been demonized by the community for using standard

Well, I know of one university hospital which got burned for double dipping. The state had some fund for indingent care. The university hospital billed the state fund for services performed on uninsured patients, but then still pursued the same patients with collection agencies. When they got caught, they played dumb and blamed it on glitches in their accounting system.

 

[militarymd]

It's a hard balance....deciding what to write off and what to go after.

I will always write off fees for hospital staff.

If I felt that I didn't perform up to par...I will write it off...ie...laboring epidural that did not go well...(one sided block, prolonged attempt, etc.)

Plastics...we get paid up front.

That's why I like my plastic surgery friend who rides a bike too.

 

[fishtolive]

being from an extended family of small business owners (from construction to karate) i can say that this happens to everybody and no amount of litigation, liens, etc. ever allows you to get what you deserve...even when you did everything right! why, people feel entitled (for whatever the reason) to free stuff.

makes me cringe when i think i'll have to be like my dad and suck thgings up when deadbeats do what they do best...get things for free. i can't even get a free coffee at the hospital!

 

[MechE]

How do you guys pay the collection agencies? Is it flat fees per case you give them or do they get a percentage of what they collect?

 

[Pooh & Annie]

So you guys that have accounting departments in your practice still have to deal with that stuff?

 

[militarymd]

percentage of collected....7% is industry standard...3% is AWESOME

 

[f_w]

7% sounds more like a billing agency (someone who translates your notes/encounter sheets into CPTs, scrubs them and submits them electronically to the insurance payors, sends bills for co-pays to the patients etc.).

A collection agency comes into play once a bill has remained unpaid beyond a certain time period. Most practices will look at bills at the 90 day mark and decide whether this is:
A just something that fell through the cracks (e.g. name mismatch on insurance card)
B a patient genuinely unable to pay
C. a deadbeat who just tries to get services for free

For A, they will typically try to resubmit the claim.
In cases of B, a payment plan is offered to the patient, the bill is at times discounted (e.g. according to a sliding scale). If it is clear that the patient has no assets or if political reasons make it unwise to further pursue it it is written off.
In cases of C the bill is sold to a collection agency at 25Cent to the dollar. From that point on, the practice has nothing to do with it and the agency can send guys with shaved heads and 2x4s after you.