It has been since the end of June that this thread stopped. I received some great information, which helped me with a lot of decisions. But, then as we moved forward, more problems popped up. So, just wondering what others do.
So, we send out a bill at 90 days letting them know that if it is not paid or a payment plan is not setup, we will be forced to send them to collections. At 120 days, we send a letter letting them know we have sent them to collections, and we will have to discharge the patient. We will continue to provide services for 30 days.
So, the 30 days comes and goes and now we have five or six "new" patients to add to the "no longer our patient list."
So, now after four months, we have maybe 20 patients minus eight who have settled in some fashion; so 12 who are either in the one month "grace" period or have been discharged.
These patients call in for something: an appt, a script, something. Our staff has to look at the list on their desks and determine if they are in collections but still our patient or not our patient. Then, they have to tell them they are no longer out patient if they aren't. Or, they just overlook it. Now we have a patient in the office who is not out patient. So, I guess I explain to them that they are no longer our patient, but I will see them this time?
I had a patient page me the other night about strep throat. And, she wanted a referral to an ENT. I knew the history and decided to go ahead and make the referral. The next day I saw the list and realized I had just referred a patient who is not our patient. Can I make that referral? Should I have made that referral?
I am used to patients no longer being our patient. But, it is more clear cut. If they send for records to trasnfer, they generally don't call us again. And, if we remember, which we would usually do, we don't see them. It isn't anxiety provoking to say, "But, you transferred two months ago." Or, I have an issue with a patient, and I dismiss them with a letter. Usually, with that type of thing I send it return receipt requested. This doesn't happen often. Maybe two to three times a year, if that. They don't tend to come back either. And, given there was an actual reason, it is easier to be up front with them. And, worse case scenario, you can print the letter out and give it to them then. While physicians will consider referring to the ED or not doing physicals during the 20, 30, 45 day period you give them, I just see them. Because they usually don't come in.
The analogy to the plumber, while completely understandable, isn't a great analogy. They don't continue to service the same client as often. They don't get paid but have to wait on the insurance or bill for a copay. They don't find themselves with a good customer who for certain reasons owe him or her $95.00. For them it is, "I fixed your sink, I need $125.00. If you don't pay it, I am not sure what they do to try to collect, but I am sure they don't work for you again, at least unless you pay the bill.
Now, you have a patient, you sent to collections. They are 15 days into the 30 day grace period. The collections thing works, and they want to set up a payment plan. They pay this for three months on time. Then, they come in and can't afford the copay. Or don't pay due to deductible. Do you dismiss them? Do you not see them right then? Do you start over? I am not arguing, it just isn't clear cut. I am wondering what others do. Especially, if they miss a payment. And, I know there are the credit card things where they automatically pay us.
Or do some dismiss them at 90 days and send to collections at 120 days? There is also a huge difference between a patient with Aetna who runs up a bill due to a large deductible and never plans on paying it. Or one with self-pay who runs up a $250 bill, but intends to just keep coming in. Those should be dismissed and sent to collections.
But, we had a MaineCare patient the other day who was $300 in debt. Generally, MaineCare will kick in and pay anything within three months. Generally, if you are MaineCare, you can go to any doctor with the understanding that you will never have to pay anything. But, something screwed up, and it went five months. My biller tried to send her to collections and dismiss her. I stopped her. For two reasons. One was because it really wasn't her fault that this happened. A 19 yo single mother is supposed to just know she needs to check and see if she has a balance. Is she supposed to call MaineCare. I don't call BC/BS every month. But, the real reason is simply business. Even if she owed me $3,000 and told me she couldn't pay $1.00 a month, I know that for the next 18 years, MaineCare will pay me.
So, anyway, maybe I didn't articulate it well, but that goes to the whole issue of why I am confused about all this. I guess part of it is, did they get the letter? Do I send it return receipt requested and fall $2.40 more in the hole? Or do I take the fact that it didn't come back that they got it.
I guess the best thing to do it, send them to collections and dismiss them in 30 days which is all sent in a letter. Then after 30 days, they aren't our patient anymore, and you just have to have that pop up when you bring their name up in the scheduler.
Just wondering if anyone else has issues like these or what their policy is.
