Collecting from Patients in Difficult Times

I admit that sometimes I’m slow to pay bills. It’s not that I can’t pay the bill, and it’s not that I have a reason not to pay the bill. It’s just a bit of a hassle, I’ve got a lot of other things going on, and bill paying just gets put aside. No malice here.

As a business downturn takes hold, we may be faced with patients who are slower to pay. Some may have lost health insurance, or are dealing with an increase in premiums and co-payments.

Collecting fees, from co-payments to non-covered expenses, requires a degree of tact and compassion. Our goal is always to develop long relationships with our patients – they should never be viewed as one time transactions. Car dealers are infamous for this attitude – while many claim they want your on-going business, they often don’t act like it.

Going to a doctor appointment is often stressful, even if the visit is “routine”. If the patient is worried – or scared – that financial difficulties will interfere with their getting care, the stress level jumps. Hard ball collection tactics will be perceived as uncaring and reflect on the physician, and may also be perceived as being overly focused on money rather than patient care.

Ask for payment of at least the co-payment at the time of service. Any signs that note this should look professional (mount it on board, rather than taping it up). Rather than being phrased as an order – “Payment is expected at time of service”, how about “We ask that co-payments be paid at the time of service”, or “Co-payments need to be paid at the time of service”.

After the carrier has paid, there is the matter of collecting from the patient. Billing should go out immediately. I’ve written before about the necessity of collecting credit cards (and the Charleston, SC area anesthesiology group which still doesn’t!). I would bill again at 30 days, and if payment is not received by about 45-50 days, I would start with a phone call. Many times patients will whip out the credit card and make a payment on the spot. The personal contact is vitally important here – by keeping this connection with a live person, the individual is more likely to pay. This concept is similar to the practice in retail stores of greeting all customers as they walk in, as this acknowledgement lessens the likelihood of shoplifting.

When calling, if you sense that a patient is having difficulty paying a bill, offer a payment plan. Try to keep the monthly amount at least $50-75, and less than six months. The goals here: to get paid, to keep the patient, and to maintain a positive relationship. Patients often will remember and appreciate someone who is considerate when they have financial pressures, which often come and go.

Yes, physicians are absolutely entitled to be paid for what you do, and physicians have been the target of reduced feeds through a price control system where they have little leverage. Nonetheless, the solution is a political one in the statehouse and the Capital, not by being heavy handed with your patients.

It’s how you say it, and how you act when asking for it.