I usually don't have a clue as to which of my patient's families actually pay for my services. I sort of like it that way. But, today my billing secretary showed me a 250 or so accounts that were more than 120 days old that each owed more than $100 USC. She said that she had written off $3700 dollars worth of accounts that were so old we were loosing money on a stamp every month. She wanted my OK to put these patient accounts into a "cash at time of service" file. I looked at the names on the list and wish I hadn't- there are some families I really had worked with that had not so much as made a token payment on account- nor had called to say that they were having monetary problems at the moment. What do I do- I can't turn away a sick child? Yet I don't run a free clinic I wish I hadn't looked at the list. I shouldn't complain- my husband's past due accounts are MUCH higher. Did you know that in rural America the surgeon that wakes up in the middle of the night to take out a sick appendix only gets paid for a little over half of the ones he takes out. I hope that if they forget to pay they at least wouldn't forget to stop to help him change a flat tire on the side of the road some other night. Kim Burlingham, MD '