Unable to Pay, Again

October 1, 2007

What is our obligation to see a current patient who has had collections issues in the past and is unable to prepay for her current visit? The patient was previously termed and then seen following full payment. But more recently she presented for an office service without means to pay. She knows she is responsible for paying at the time of service. As a previous collections account, we require cash up front.

Question: What is our obligation to see a current patient who has had collections issues in the past and is unable to prepay for her current visit? The patient was previously termed and then seen following full payment. But more recently she presented for an office service without means to pay. She knows she is responsible for paying at the time of service. As a previous collections account, we require cash up front.

Answer: I would say you need to set a policy - it really can be whatever you like - and stick to it. It sounds like you already have a policy that calls for the dismissal of patients if they don’t pay. My question: If they do subsequently pay, what is their status?

If your policy prohibits patients from being seen unless they pay, then don’t see this patient (or make this a written policy and apply it to all patients in the future).

You are not obligated to see any patient who does not pay, though if you are going to dismiss them, you are under an obligation to provide written notification and provide care for 30 days so she can find a new provider.

You certainly can sit with the patient to learn about her circumstances and offer options. Maybe she is eligible for Medicaid or can use some other need-based clinic. Or perhaps she can commit to a payment plan.