Bert, from a legal standpoint it is very important to stick with your policy and not play games in the realm of 'patient abandonment.' They should all go to collections after 3 unpaid statements if they will not set up a payment plan or make any attempt to address the bill. Doctors just aren't good business people in many cases. Think how a lawyer, plumber, mechanic, cell phone company or anyone else would do it. Despite your good intention, you aren't helping them in life by teaching them to be irresponsible and rack up bills they cannot pay.
Once they go to collection, you are turning the bill over to someone else and you will not be paid the full amount. At this point, you need to discharge them or you will get into a big mess as they continue to present without paying. They are also more likely to sue you after you send them to collections if you keep seeing them. Tell them it is the office policy to send them to a different doctor after they have gone to collections, as they have made no attempt to settle their bill over 90-120 days of reminders. Make sure your letter tells them how to find a new doctor, what urgent care offices and ER facilities are open, and to call the local hospital for referral ideas or their insurance company. Tell them they have serious medical problems they need to follow ASAP with their new doctor, and that records will be promptly released on a signed ROI receipt. Give them 30 days and do NOT see them again. If you see them again, you 're-establish' them legally as a patient, and you are responsible for them from then on. There must be no gray area here concerning whether they are your patient or not. After the CERTIFIED discharge letter, I set a reminder in AC for 30 days to INACTIVATE them. No need to keep a list: they are not your patient at that point. If they call, the staff asks, "did you get the doctor's discharge letter?" Well, we have a signed certified copy. Please read this again and take appropriate actions.
You Said:
"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?"
You have now established a doctor-patient relationship again with the above patient. You have to do another discharge letter of 15-30 days and not establish with them again. You are accountable on following up on that referral, liable if they do not go, etc.
When people say they are transfering, and ask for records, instead of a discharge letter I make them sign a form that says they are withdrawing care on this date and have received a free, full copy of their medical records. Any future requests will come with the usual record research and copy charges. Put that signed patient withdrawal form into their chart!
In your plumber analogy, you have to pay the bill or collections, small claims court perhaps. They do not ever work for you again. Although he is a kind person, he will tell you to go elsewhere and will not fix your sink, even if it is flooding your house. That is your problem and your burned your own bridge. Why should people abuse doctors any more than plumbers?
You said:
"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"
You discharge them when they go to collections. They had a chance for a payment plan, as offered, BEFORE they went to collections.
This being said, I am not a lawyer and it is only my 2 cents, and the above should not be construed as legal advice. I give people every chance, and if they a reasonable person with a large balance, I will often offer to settle up for half if they are in trouble. But they must make some attempt at being an honest person. I also give free charity care. But it is always my decision to give free care, and as such, it is a free gift of my time and expertise. It is not taken by force from an abusing person, because that is not a gift at all.
