While I'm sure this is universal in small practices, I think the issue is worse with Pediatric practices.
One reason is that often the parents are young and don't either have a lot of resources or understand the insurance/medical payment system.
Another reason is that Pediatricians in general are more forgiving than some other specialties (IMHO).
Medicaid for us is the easiest insurance. (Other than CHIPs patients) There are no copays and no deductibles. They probably have the lowest denial rate. They are also our largest insurance so they are more predictable. Many other physicians refuse to take Medicaid but 40% of all children in the country are under this insurance and many areas are higher. It's difficult in many areas not to take it. In Illinois they only pay about 60% of what private insurance pays but this is somewhat offset by it being easier.
Recently Illinois went into Medicaid Managed Care. It started out as 10 plans then dropped to 5, then they added back 2. Each plan has different rules and regulations and requires different information. While pushed by the federal government, it feels as though this was just to confuse, divide and conquer. I have patients who are switched in plans (some of which I do not take) without asking or notification but come in and can't be seen. Sometimes I will see them for free, sometimes I charge them, sometimes I turn them away. I have parents where siblings are assigned to different plans and are told they cannot change for a year. Truly a mess.
I try to set up payment plans when patients come in. We use the yellow sticky box to alert staff quickly to patients with a balance and they cannot make an appointment unless an agreement is made. If they pass on the appointment staff will note that in the yellow sticky. I will release records if they leave but make them come in to get them unless it is out of the area.
