Dismissing Noncompliant Patients

Question: Do I have to keep a noncompliant patient?

Answer: No. If a patient is causing such problems that you would like to remove him from your practice, there are a couple of guidelines to follow.

First, a patient must be given 30 days to seek care from another provider. So if the patient presents five days after you have dismissed him, you must see him.

Second, you are required to inform the patient that he has been dismissed - not just suddenly refuse to see him. Try notifying him in writing via certified mail. The law doesn't dictate this, but that way, you can prove that you did indeed inform the patient. File and keep the letter and the receipt for the certified letter.

Third, it is advisable, although not legally required, to have a standard policy for dismissal that is communicated to both patients and staff. The benefits are clear communication and consistency. You don't want one patient dismissed because he didn't pay a $5 balance that was only 10 days old, while another was kept on until she had a $5,000 balance that was three years old. Exceptions to the policy you determine should be exceedingly rare.

Fourth, although the law doesn't dictate this either, it's wise to give patients a warning before you dismiss them. There may have been a misunderstanding. Make sure the patient knows the potential consequences of his actions.

Finally, if you are in the middle of a course of treatment, contact your malpractice carrier to review the case prior to dismissing the patient. If, for example, you performed surgery on the patient last week and don't want to do the post-operative care he requires, you should consult with your carrier. You don't want a lawsuit on your hands.

Remember that there are no rules that dictate specific reasons for dismissal, so these vary from practice to practice. Most patients are dismissed for financial reasons - not paying their bills - but some are dismissed for noncompliance.