Practice Management Alert

Question: How should I handle a disgruntled patient who absolutely refuses to pay the copayment or deductible?

Minnesota Subscriber
 
Answer: Your practice needs a policy on how you will handle copayments when patients refuse to pay. The policy should address who handles the patient (supervisor, manager, etc.) and whether the patient who refuses to pay is sent to the billing department to make arrangements to be billed.
 
For example, if your policy is that copays are paid before the patient sees the doctor, they should be collected at check-in. Deductibles pose a different problem because they are collected after the services are rendered. Your practice has to decide whether it will ask patients to pay their deductibles at checkout, or balance bill the patient after the insurance company has paid its share, and adopt a policy on handling deductibles.
 
The majority of practices balance bill the patients. It is permissible, however, to ask for the deductible payment at checkout on the day of the visit, and it can be done with Medicare patients. If the patient refuses to pay the deductible and is expressing anger in your office, escort the patient out of the checkout area to a more private location.
 
Then, have the patient speak to the practice manager or billing manager about the problem. At that time, the person dealing with the upset patient needs to try to diffuse the anger by asking the patient what can be done to help. Remind the patient that you've got a contract with the payer that obligates you to collect the deductible and that the patient has a contract with the payer that requires payment.
 
If you charge $100 for the visit, the insurer with the typical 20 percent deductible will pay $80, and the patient is responsible for $20. If the patient doesn't pay, the practice is obligated to refund the payer because it has, in effect, charged the insurer incorrectly. The patient needs to know this. Tell the patient that refusing to pay may result in cancellation of coverage.
 
Inform the patient you are required to tell the insurer that the patient has refused to pay. You can also ask the insurer for a copy of the company's policy on payment of deductibles to use to support your position. Then, work with the patient to try to collect the money.