Writing off "bad debt" ?

[tmvguy03]

How do you guys handle patients with debt to your clinic? My situation is a little different because it is somewhat of an academic/private hybrid so I am not sure what control I have in this situation.


I have been noticing a trend (not a huge number of total patients however) who have private insurance, and yet have not been paying for procedures, office visits etc. on the back and after it is been submitted to their insurance. I have been told by some of the powers that be that " these are high deductible plans". So.... If you have a high deductible plan, and do not want to pay the out-of-pocket expense to meet the deductible, apparently you can continue to receive "free" healthcare in our clinic and it will eventually be written off as bad debt?


For select situations, I will see patients for charity care, especially if it is for diagnostic procedures for surgery etc., or if it is an established patient who is between jobs, has run into a bad situation etc., but I take serious issue with providing free healthcare to those who are insured but do not want to pay their out-of-pocket expenses for their insurance plan. Terrible precedent. I think patient be blocked from future scheduling until a payment plan has been set up, and implemented.

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[gdub25]

We have a system in place to where 3 full time employees run a benefits and eligibility report for every patient before they’re scheduled visit with us. Then they update the patients chart with out of pocket, deductible, co-insurance etc so we know what they’re situation is. They also see what their balance is and like you mentioned, if they have a high deductible plan and have gotten 3 ESIs for the year, trying to schedule for a 4th toward the end of the year but insurance hasn’t paid anything on the first 3 and the patient hasn’t paid anything and still haven’t met deductible then we don’t let them schedule. General rule of thumb is that if they owe us $500 or more and insurance isn’t covering the cost of us seeing them then they don’t get to schedule with us.

 

[SSdoc33]

 

[drusso]

How do you guys handle patients with debt to your clinic? My situation is a little different because it is somewhat of an academic/private hybrid so I am not sure what control I have in this situation.


I have been noticing a trend (not a huge number of total patients however) who have private insurance, and yet have not been paying for procedures, office visits etc. on the back and after it is been submitted to their insurance. I have been told by some of the powers that be that " these are high deductible plans". So.... If you have a high deductible plan, and do not want to pay the out-of-pocket expense to meet the deductible, apparently you can continue to receive "free" healthcare in our clinic and it will eventually be written off as bad debt?


For select situations, I will see patients for charity care, especially if it is for diagnostic procedures for surgery etc., or if it is an established patient who is between jobs, has run into a bad situation etc., but I take serious issue with providing free healthcare to those who are insured but do not want to pay their out-of-pocket expenses for their insurance plan. Terrible precedent. I think patient be blocked from future scheduling until a payment plan has been set up, and implemented.

You collect the patient responsibility upfront and refund the patient the difference if there is one: "Mrs Smith, I see your responsibility for the procedure today is $300. How would you like to pay Dr. Drusso today? Check (we call and verify funds), Visa, MC, AMEX?"

Otherwise, you're literally rolling dice and betting on the come. You could be busy all day and still go broke with that policy. I would fire my Admin for dishonorable conduct and business negligence if they put my livelihood at risk that way. Bad debt will demoralize and sink you.

 

[Ligament]

They pay the debt before they see me, or they go to collections. No payment plans. I'm not a bank, or better yet, a hospital with not for profit status.

 

[Boriken Pain]

What companies do you use when sending patients to collections?

 

[drusso]

What companies do you use when sending patients to collections?

By aggressively collecting what you're owed upfront, you'll obviate the need to send patients to collections. We offer Care Credit, Go-Fund-Me URL's, and can recommend a pawnbroker if they need quick access to cash. The reality is that you don't want to send patients to collections. It creates ill-will in the community. You'll run into PCP's and Surgeons at kids' events, social gathering, church, etc and they'll mention that patients said you sent them to collections. Just collect upfront. Eat your spinach. Good for everyone.

 

[lobelsteve]

Drusso Pain n Pawn

if the stem cells don't cure you, buy a .44Magnum

 

[SSdoc33]

By aggressively collecting what you're owed upfront, you'll obviate the need to send patients to collections. We offer Care Credit, Go-Fund-Me URL's, and can recommend a pawnbroker if they need quick access to cash. The reality is that you don't want to send patients to collections. It creates ill-will in the community. You'll run into PCP's and Surgeons at kids' events, social gathering, church, etc and they'll mention that patients said you sent them to collections. Just collect upfront. Eat your spinach. Good for everyone.

not so sure it is good for grandma smith who needs to sell her old engagement ring to afford an ESI (or PRP, etc)....

gofundme? i know you have a business to run, and i respect that, but doesnt that just make you feel dirty? strike that question, im sure ill get a SOS/anti hospital response.

 

[Cholula]

I'm trying something new this year. After giving up on years old bad debt, I'm submitting 1099-C's, cancellation of debt, to my nonpayers and the IRS. It doesn't help me but at least it will be taxable income for them that they will owe tax to the IRS.

 

[Ligament]

You collect the patient responsibility upfront and refund the patient the difference if there is one: "Mrs Smith, I see your responsibility for the procedure today is $300. How would you like to pay Dr. Drusso today? Check (we call and verify funds), Visa, MC, AMEX?"

Otherwise, you're literally rolling dice and betting on the come. You could be busy all day and still go broke with that policy. I would fire my Admin for dishonorable conduct and business negligence if they put my livelihood at risk that way. Bad debt will demoralize and sink you.

So currently we collect about 50% of patient responsibility up front, but we do have a small handful that go to collections per month as well. Even with 50% of patient responsibility collected up front, we have some patients that whine and complain or even refuse at the front desk and walk out.

I'm considering changing to 100% of patient responsibility, but presume that will cause patients to cause more of a scene.

The local mega clinics and hospitals do not charge anything up front and in fact often don't collect any payments from patients ever, since they have not for profit status and often tens or hundreds of millions of dollars in cash sitting in the bank. Therefore patients get upset at us since their megacorp doctors don't ask for any payment.

Thoughts from anybody else in private practice doing this (if there are any of you left in private practice...)?

 

[drusso]

not so sure it is good for grandma smith who needs to sell her old engagement ring to afford an ESI (or PRP, etc)....

gofundme? i know you have a business to run, and i respect that, but doesnt that just make you feel dirty? strike that question, im sure ill get a SOS/anti hospital response.

I'm not sure what you're talking about. I would never disparage someone else's decision to do whatever they need to do (lawfully) to prioritize their finances for health and wellbeing. However, I do detest the predatory billing practices of nominally "not-for-profit" health systems and have gone on the record opposing medical surprise billing:

http://bizj.us/1pzltw

Hospitals face sharp criticism for aggressive billing practices

The powerful American Hospital Association has stayed largely silent about its members suing thousands of patients for overdue bills, seizing homes or wages and even forcing families into bankruptcy.

www.stltoday.com

I think it is respectful and honors another person's dignity to counsel them transparently about what their financial responsibilities are in their own health care decisions.

 

[drusso]

So currently we collect about 50% of patient responsibility up front, but we do have a small handful that go to collections per month as well. Even with 50% of patient responsibility collected up front, we have some patients that whine and complain or even refuse at the front desk and walk out.

I'm considering changing to 100% of patient responsibility, but presume that will cause patients to cause more of a scene.

The local mega clinics and hospitals do not charge anything up front and in fact often don't collect any payments from patients ever, since they have not for profit status and often tens or hundreds of millions of dollars in cash sitting in the bank. Therefore patients get upset at us since their megacorp doctors don't ask for any payment.

Thoughts from anybody else in private practice doing this (if there are any of you left in private practice...)?

How the "other half" lives...

Patients Eligible For Charity Care Instead Get Big Bills - KFF Health News

Nonprofit hospitals admit they sent $2.7 billion in bills over the course of a year to patients who probably qualified for free or discounted care.

khn.org

"Together, they estimated they had given up collecting $2.7 billion in bills sent to patients who probably would have qualified for financial assistance under the hospitals’ own policies if they had filled out the applications.

These written-off bills, known as bad debt, represented a tenth of all nonprofit hospital bad debt reported to the IRS in either 2017 or the most recent year for which data is available. That sum may represent an undercount because it is based on self-reported estimates from hospitals and is not independently audited. And it does not include money that financially struggling patients eventually paid."

 

[SSdoc33]

I'm not sure what you're talking about. I would never disparage someone else's decision to do whatever they need to do (lawfully) to prioritize their finances for health and wellbeing. However, I do detest the predatory billing practices of nominally "not-for-profit" health systems and have gone on the record opposing medical surprise billing:

http://bizj.us/1pzltw

Hospitals face sharp criticism for aggressive billing practices

The powerful American Hospital Association has stayed largely silent about its members suing thousands of patients for overdue bills, seizing homes or wages and even forcing families into bankruptcy.

www.stltoday.com

I think it is respectful and honors another person's dignity to counsel them transparently about what their financial responsibilities are in their own health care decisions.

sigh. typical response right on cue.

my point is, you must have a lot of faith in the success of your treatments to charge patients enough that they need pawnbrokers and go-fund-me pages. it is a slippery slope, especially when you are offering less than standard treatments (IE: regenerative therapies). this is a captive, vulnerable, population. they would cash in their 401k for less pain. lets just hope you can deliver on your promises.....

 

[drusso]

sigh. typical response right on cue.

my point is, you must have a lot of faith in the success of your treatments to charge patients enough that they need pawnbrokers and go-fund-me pages. it is a slippery slope, especially when you are offering less than standard treatments (IE: regenerative therapies). this is a captive, vulnerable, population. they would cash in their 401k for less pain. lets just hope you can deliver on your promises.....

I offer all therapies with evidence. Our state Medicaid system doesn't pay for any pain procedures (ESI, RFA, MBB, etc) so people who want them have no other choice accepted to assume their own financial responsibility. This is what rationed health care looks like.

 

[SSdoc33]

I offer all therapies with evidence. Our state Medicaid system doesn't pay for any pain procedures (ESI, RFA, MBB, etc) so people who want them have no other choice accepted to assume their own financial responsibility. This is what rationed health care looks like.

fair enough. ill support the ESIs and RFAs.

charging the indigent a proverbial arm and a leg for the cellular goo is another story.....

 

[drusso]

fair enough. ill support the ESIs and RFAs.

charging the indigent a proverbial arm and a leg for the cellular goo is another story.....

I don't know what you're talking about with charging an arm and a leg: The cost in the office is 1/3 what it would cost in an HOPD/ASC. They're saved a huge facility fee. I don't begrudge any patient--rich or poor-- for doing what they have to do to be financially accountable: Put up a go-fund-me page, take out a pay-day loan, etc. We are completely transparent about the cost to the patient. No surprise bills.

And, why would you trust the state to be the arbiter for coverage about one kind of procedure (traditional IPM) and not another (emerging Regen Med)? It seems like they do an equally poor job evaluating both. I've even tried to get SCS covered for FBS with no avail. It's considered "experimental." Say it out loud: "Coverage does not equal care." You can have all the "coverage" in the world and still be out-of-pocket for a PRP for lateral epicondylitis or an ESI for sciatica.

These people (the working poor) are just trapped in a government-run health care system. The state health policy wonks think any SIJ injection is experimental and therefore "non-covered" doesn't matter if its steroid, PRP, local anesthetic, or hyaluronic acid. Can you imagine how much worse it would be with the Feds calling the shots? Government rationing is NOT the direction we want to go for the rest of the country.

 

[SSdoc33]

I don't know what you're talking about with charging an arm and a leg: The cost in the office is 1/3 what it would cost in an HOPD/ASC. They're saved a huge facility fee. I don't begrudge any patient--rich or poor-- for doing what they have to do to be financially accountable: Put up a go-fund-me page, take out a pay-day loan, etc. We are completely transparent about the cost to the patient. No surprise bills.

And, why would you trust the state to be the arbiter for coverage about one kind of procedure (traditional IPM) and not another (emerging Regen Med)? It seems like they do an equally poor job evaluating both. I've even tried to get SCS covered for FBS with no avail. It's considered "experimental." Say it out loud: "Coverage does not equal care." You can have all the "coverage" in the world and still be out-of-pocket for a PRP for lateral epicondylitis or an ESI for sciatica.

These people (the working poor) are just trapped in a government-run health care system. The state health policy wonks think any SIJ injection is experimental and therefore "non-covered" doesn't matter if its steroid, PRP, local anesthetic, or hyaluronic acid. Can you imagine how much worse it would be with the Feds calling the shots? Government rationing is NOT the direction we want to go for the rest of the country.

i know it is hard for you to stay on topic without going off on the inequalities in hospital vs office based care: but just try for a bit

nobody covers PRP/regenerative therapies. its cash based everywhere (essentially). i really just hate the idea of charging a "lot" of money for ANY of these treatments. especially on patients who really cant pay. is it their decision in the end? sure. of course. but it is very easy to take advantage of the situation. there is not a huge difference between PRP into a SIJ and stem cells into a disc. tread lightly...

 

[drusso]

i know it is hard for you to stay on topic without going off on the inequalities in hospital vs office based care: but just try for a bit

nobody covers PRP/regenerative therapies. its cash based everywhere (essentially). i really just hate the idea of charging a "lot" of money for ANY of these treatments. especially on patients who really cant pay. is it their decision in the end? sure. of course. but it is very easy to take advantage of the situation. there is not a huge difference between PRP into a SIJ and stem cells into a disc. tread lightly...

Wrong: Self-insured plans cover regenerative procedures.

Your SOS denialism and Semmelweis reflex are tiresome. I think your ideology blinds you from real facts about cost drivers in the health care system. It's not the cash pay patient who is driving up costs.

Hospitals are in the crosshairs over patient referrals

Hospitals don't want patients to leak to competitors.

www.axios.com

"The former CFO of Community Health Network, a hospital system in Indiana, alleged the system employed physicians with "excessive" salaries well above fair market rates as a way to secure those physicians' referrals, and then bill higher rates for hospital services."

 

[SSdoc33]

Wrong: Self-insured plans cover regenerative procedures.

Your SOS denialism and Semmelweis reflex are tiresome. I think your ideology blinds you from real facts about cost drivers in the health care system. It's not the cash pay patient who is driving up costs.

Hospitals are in the crosshairs over patient referrals

Hospitals don't want patients to leak to competitors.

www.axios.com

"The former CFO of Community Health Network, a hospital system in Indiana, alleged the system employed physicians with "excessive" salaries well above fair market rates as a way to secure those physicians' referrals, and then bill higher rates for hospital services."

i said "essentially"

you immediately went right back to your schtick. it is laughable

 

[drusso]

i said "essentially"

you immediately went right back to your schtick. it is laughable

I'm a maven when it comes to transparency and fairness for patients.

 

[SSdoc33]

I'm a maven when it comes to transparency and fairness for patients.

Oh, I see. What we got here is a crusader.

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[deleted993114]

They pay the debt before they see me, or they go to collections. No payment plans. I'm not a bank, or better yet, a hospital with not for profit status.

It's bad PR.

You can't get blood out of turnip and the bad PR is not worth the potential gains (which are very small).

 

[Ligament]

It's bad PR.

You can't get blood out of turnip and the bad PR is not worth the potential gains (which are very small).

The potential gains are I get to pay my bills and my staff and not go out of business, so I don't understand your comment that such gains are very small. I cannot afford to treat patients who do not pay me.

 

[swamprat]

The potential gains are I get to pay my bills and my staff and not go out of business, so I don't understand your comment that such gains are very small. I cannot afford to treat patients who do not pay me.

i agree. Maybe he is referring to sending to collections Being bad PR which I could understand it’s pennies on the dollar. But yeah especially now ppl have to meet their deductible again or their insurance switched and they have to pay out of pocket for their office visit -they often lie and say they can’t afford it or it’s not fair. I tell office staff they need to pay or they won’t be seen. Sure enough they all seem to come up with the money.

Also to add some patients choose a high deductible plan knowing they utilize their insurance frequently. They know what their specialist office visits are prior to signing up. It’s their own fault

 

[NJPAIN]

The potential gains are I get to pay my bills and my staff and not go out of business, so I don't understand your comment that such gains are very small. I cannot afford to treat patients who do not pay me.

100% agree. You don’t pay the mechanic and he keeps your car. You don’t pay ANYONE and they take you to court. But, you don’t pay your doctor and he says “ that’s ok, GOD bless you, be well’”. Huh? Also, other doctors need to keep their nose out of your business. If I have a patient complain about another physician’s charges I generally draw an analogy to their own work and essentially say “ do you provide service to your employer or clients for free?


Sent from my iPhone using Tapatalk

 

[Ducttape]

I admit... it is a bummer that all of medicine is now about money.

whether its drusso complaining about hospitals, or hidden fees, or private docs suing patients...

the one thing I do miss about ER work was that $$$ never factored into my decision making regarding patient care.

 

[drusso]

I admit... it is a bummer that all of medicine is now about money.

whether its drusso complaining about hospitals, or hidden fees, or private docs suing patients...

the one thing I do miss about ER work was that $$$ never factored into my decision making regarding patient care.

No ER doc ever worries about $$$ if they're out-of-network!

Private Equity Tries to Protect Another Profit Center

The fight in Congress heats up over surprise medical billing, another abuse of the public driven by the private equity industry.

prospect.org