> >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 Kim, If you and your husband don't already have a collection agency, now's the time. Even though you practice in a rural area, you've written that there are other pediatricians in your area families have switched to, so it sounds like other care is available if you stop seeing somebody for non-payment. I've found that too many families are able to pay, they just choose not to because they can get away with it (and we, as health care providers, are one of the only professions to put up with it). They have the attitude that the doctor doesn't need the fifty or one hundred dollars anyway, but when you have 250 accounts of that size (as you've written), that'll pay for a lot of rent. I've been in practice for eight years and didn't send anybody to collections for about the first four years. I'd believed that people were basically good and would pay the bills if my office treated them nicely and respectfully and that a collection agency would only antagonize them and make them not want to pay. Plus I figured that I'd be giving away 50% to the collection agency when I could keep 100% myself. It took quite awhile to realize that 50% of something is more than 100% of nothing. Many times my smart office manager would give me "The Look" when I'd say, "Don't send them to collections. They're really nice and I'm sure they'll pay eventually." Of course they never would. Trust your office manager's sense - he/she should know the folks truly having a tough time vs the deadbeats. One mother who disappeared once we sent "The Letter" for the past due amount showed up three years later with a new baby under a different name and acted surprised that we'd remembered her (we made her pay that visit fully and part of the old balance, then never heard from her again). One mother told us flat out, "I'll pay you if I want to and I won't if I don't!" (I'll bet she wouldn't say that when presented with the check at a restaurant). Because I actually liked her I got personally involved and she told me she was refusing to pay because of my office manager's "attitude". Interesting, but the only people who've ever complained about attitude were the ones who had large balances and always had an excuse ready. One uncomfortable situation is when the children have a social relationship (probably even worse in a small town). My daughter decided she liked a boy named Zachary in her pre-school. But Zachary's mom still had a balance outstanding when her insurance changed (and she changed pediatricians) the previous year, and funny thing, the check had been in the mail for that whole year. At one pre-school function she stuffed a check (for about 25% of what was owed) in my shirt pocket and said (with a phony smile), "Now you can tell your office manager to stop bothering me". By the time she was finally sent to collections she owed not much more that $100.00 but the collection agency owner is taking her to court over such a relatively small amount because, as he put it, he'd "never dealt with someone with such a bad attitude." She also wore expensive clothing and drove a brand new luxury car so she couldn't cry poor. It's a cliche, but the older an account gets the harder it is to collect. If you've sent "The Letter" and haven't collected at least something, more letters will just cost you postage now and collection potential later. The families who are really in a financial bind will at least return calls and send a good-faith token payment. Those families I'm more than willing to see at a discount or for no charge. The rest will usually just be using you for free medical care until you get tough, then they'll work their scam on another office. Or think of it this way - they're stealing from you. They're stealing your time, expertise, office supplies, and vaccines (which you've paid for). Once I came to face this reality, sending them to collections became much easier. And I no longer put a lot of time and emotional energy into trying to keep families like this in my practice. Sorry for such a long post. I hope people find it useful. It sure was therapeutic writing it :) Michael Sachs, M.D. General Pediatrician