Don't Let Patients Take Advantage of Your Medical Practice

I met with a colleague yesterday for a nice lunch and great conversation. She and her husband are small business owners and have two clinics in the area; truly dynamic people who are always willing to help someone out who needs it. The dilemma: They are too trusting to a fault. By her own admission, mind you. She described several situations where they have been taken advantage of by people they thought were friends or even other close colleagues. This woman does not have a "victim" attitude, rather she would never behave in a poor and selfish fashion so that is never her first thought when lending a hand or "giving someone a break."

Let me tell you, there are plenty of people who will take advantage of your good nature, and are most likely doing so right now. I have recently encountered a few over the past several months. This scenario may ring a bell to you, as I'm sure you have experienced this, as well.

There was a patient, Mr. Smith, who insisted that a physician bill his wife's insurance (a really stinky Aetna plan) knowing full well the insurance was going to deny the treatment because she had exceeded her plan limit on that treatment for the year. Once the insurance denies the claim, the patient wanted the physician to fight the insurance plan on his behalf to get the claim paid.

Let me tell you what is wrong with this situation:

1. As a medical professional, you are billing a patient insurance plan as a courtesy, not as a requirement.

2. With the stinky Aetna plan they possessed, the payment for the claim was under the break-even point for the appointment.

3. When the billing department employed by the physician had to try to appeal (and lost) the claim, they had to spend significant time gathering the required information, writing the appeal letter, reprinting the claims, etc. This is more administrative cost taking away from the profit of the already costly (for the physician) appointment.

4. Did I mention that the couple who had the stinky Aetna plan lived in a very prestigious area and were multi-millionaires?

5. Patients should never get to dictate your policy. If you know that a treatment is going to get denied, call the insurance company and explain that the patient needs the treatment and ask to charge them the plan cash rate for the treatment. By letting the insurance company know this is your plan, you have not breached your contract with them, and you are paid immediately.

6. By knowing the denial was going to deny, and then an appeal made, you have stretched that claim out into your 60-day to 90-day category.

All of these reasons are just an unacceptable way to manage your billing of claims, and this is just one scenario. Remember that you run your business, you make the rules, you follow your contract obligations, and you should never have to lose money on any claim because a patient tells you to. Where will they be when you close your doors? At one of your colleagues doing the same thing to them, that's where.

Educate your front- and back-office staff along with your billing staff on your policies and never as the "norm" perform below your own standards. There is a fine line between customer service and people taking advantage of you. Write-down situations like these are start finding that line. Your accounts receivable and bank account will thank you.