Patient dismissal

September 1, 2006

I have a patient who has not been in the office in several years. Her account was turned over to collections. She called yesterday stating she was pregnant again and is without insurance. I informed her that she had been turned over to collections and we could not see her. She offered to pay her balance - from 1999.When I pulled her chart I found that we had never sent her a letter of withdrawal. What are my options? Do I have to send her a letter stating we will see her for 30 days for an emergency? She had long been aware of her balance and that she was turned over to a collection agency.

Question: I have a patient who has not been in the office in several years. Her account was turned over to collections. She called yesterday stating she was pregnant again and is without insurance. I informed her that she had been turned over to collections and we could not see her. She offered to pay her balance -- from 1999.

When I pulled her chart I found that we had never sent her a letter of withdrawal. What are my options? Do I have to send her a letter stating we will see her for 30 days for an emergency? She had long been aware of her balance and that she was turned over to a collection agency.

Answer: You've discovered the perils of not having (or not following) a written policy on this subject. You should develop such a policy now. It will allow you to treat all your patients the same, and keep you from getting in this boat again. (Make sure you don't already have a policy that everyone has forgotten about. If you do, review it and either start enforcing it or replace it with something else.)

Here is the norm for written policies:

  • Detail the circumstances under which a patient will be dismissed and policies for making sure a dismissal letter is sent.



  • If the patient has been dismissed for administrative reasons -- as opposed to clinical noncompliance -- the most common policy is to allow the patient to resume care if 100 percent of the outstanding balance is taken care of.



  • Some groups have decided that once a patient is dismissed, the practice will no longer agree to extend credit, even after readmitting the patient. That is, the patient has to pay 100 percent of her bill at the time of service, and she can file her own insurance if she wishes. Further, some practices will no longer schedule an appointment with a previously dismissed patient, instead treating the patient on a walk-in basis only.



  • For clinical noncompliance, your policy should include a review by the physician. The physician needs to decide whether to resume care. This issue of clinical noncompliance can be very sticky, and we recommend discussing it with your malpractice carrier.

As you do not have such a policy and did not formally dismiss her, why not treat her if she pays off her balance and pays upfront for her treatment this time around?

If you don't want to do that, yes, I'd suggest sending her a formal letter of dismissal that includes you continuing to see her for 30 days until she has time to find a new provider.