Collecting Patient Balances

September 1, 2007

Despite our best efforts, we continue to be faced with patients who do not make much of an effort to pay their balances. I don't want to abandon these people, yet I don't want to be a patsy. We have tried such actions as not rescheduling until they have paid their balance, or at least a portion. Also, we have told those who have substantial balances and were no-shows for their last appointments, yet want us to call in meds, that we would be happy to work them into the schedule, but they must do their part and make payment before being seen. Any suggestions?

Question: Despite our best efforts, we continue to be faced with patients who do not make much of an effort to pay their balances. I don't want to abandon these people, yet I don't want to be a patsy. We have tried such actions as not rescheduling until they have paid their balance, or at least a portion. Also, we have told those who have substantial balances and were no-shows for their last appointments, yet want us to call in meds, that we would be happy to work them into the schedule, but they must do their part and make payment before being seen. Any suggestions?

Answer: One suggestion is to make this less of a moral issue for you personally. Set a rule in writing, and give it to all new and existing patients. It should clearly explain that patients are expected to pay and spell out the consequences for not doing so. Those consequences can be whatever you like. All accounts more than 65 days late will be sent to collections, for example. All patients with accounts higher than a determined amount or more than eight months old will be dismissed from the practice. Whatever.

Once you set the rules, you’ll know you are treating everyone the same, and you’ll stop torturing yourself over every decision.

In addition, do what you can to collect at the time of service, when you have the patient in front of you. The chances of successful collection plummet when you send statements in the mail. If you do send a statement, make sure it’s clear what the patient owes.

Include language explaining that patients can call the office to set up a payment plan. Don’t send more than three invoices; forward the debt to collections before it’s too late. As for how to handle patients who call in for prescription refills after failing to pay bills and missing appointments:

  • Separate the issues. It’s one thing not to prescribe drugs because you aren’t sure about the patient’s condition, and another thing entirely to do it punitively. Include this scenario and a rule in your written policy.

  • Have someone handling these calls who can really get to the heart of the matter. Why is the patient not coming in or not paying? Can they not get off work? Not get transportation? Do they need childcare? Could they pay in smaller increments instead of all at once?

For people who are not chronic offenders, they may just need a little help sorting it out.