When Patients Don’t Want To Pay Their Co-Pays

 We’ve all treated those patients who don’t pay after your practice renders services or are resistant to paying co-pays. Here are some suggestions for handling these situations.

1. “Why do I have to pay a co-payment (or fee for office visit) if I only spoke to the doctor? I mean, he didn’t do anything.”

In any disputed financial case, your first matter of business is to educate your patient. Response: “A consultation during which the doctor discusses medical advice, a treatment plan and/or recommendations is considered an office visit. According to your insurance card, you agreed and are responsible to pay a [$xx.xx] co-pay at each office visit as well as an annual deductible any time you are scheduled to see the doctor. Since we saw you in our office on [date] and we do participate in your plan, it is our responsibility to collect that co-pay/balance from you. Failure to do so puts us both in violation of your contract. I’m sure you don’t want that and neither do we. Will you be paying by cash, credit card or check?”

2. “I forgot my wallet,” “I cannot pay today,” “I have to pay a deductible?” or any other excuse du jour.

Uncovered services: The question you want to ask yourself is: does this happen on a regular basis or is it a one-time occurrence? That should make a difference in how you respond. Response (one-time occurrence): “Oh, sometimes those things happen, Mr. Jones. I can call you later today and you can just give me your credit card number over the phone so I can process your payment and avoid sending you a statement.” Your financial policy should dictate what occurs for repeat offenders.

Co-pays: Insurance companies require that patients pay at the time of service. Don’t be fooled. Patients know this arrangement. For this reason, it is always beneficial to collect co-pays upfront because if patients do not pay, you are not obligated to treat them. If patients incur additional expenses while in the treatment room (supplies, services, etc.), collect the additional fee upon discharge. (One can run credit cards twice.)

Response: “As noted on your insurance card, your co-pay is due at the time of service and because we are contracted with your insurance company, we are responsible to collect it. Will that be cash, credit card or check?”

Deductibles: Collect deductibles as noted in your financial policy. You could wait until you receive an explanation of benefits (EOB) detailing the patient’s deductible responsibility. However, again, collecting upfront is a guarantee of payment, bird in hand. You can always reimburse the patient any overpayment received from insurance company.

3. “I have an accountant who handles all my bills.”

Take this opportunity to review your financial policy with the patient (and his or her agreement by signature), indicating that payment is required at the time of service. You might even want to give the patient another copy and suggest sharing it with the accountant.

Response: “We try very hard to avoid sending out statements and that time savings allows us to give more of our attention to our patients. We do accept credit card payments and, in fact, that method of payment will actually allow your accountant to effectively consolidate your charges and better manage your money matters. I’m happy to take your credit card number now and to make it more convenient in the future (if HIPAA security measures are in place) keep your number on file.”

4. “Why doesn’t my insurance cover this? I pay a lot of money for them to pay for my medical services!”

Response: “I understand your confusion, Mrs. Brown. We deal with numerous insurance plans and every one of them is different so your particular question is difficult for me to answer. The plan you chose is between you and your insurance company. If you are not satisfied with the benefits offered, you may want to contact the insurance company to reevaluate your benefits and maybe even switch to a plan more suited to your medical needs.”

5. When a problem patient (with a delinquent account) wants to return.

Create a set policy to deal with this for consistency and the uniform treatment of all patients. Prior to rescheduling a delinquent-paying patient, request payment for his or her past due balance, and then inform the patient that you will collect the necessary payment for his or her new appointment upfront at the time of service. Also review your financial policy when these patients come in and have them sign (or re-sign) a written copy as a reminder of their financial obligations. 

Response: “Mrs. Smith, I would be happy to schedule you for another appointment. However, we must first collect the outstanding balance from [date]. I can take a credit card number over the phone to clear that up for you now. Your new appointment is scheduled for [date]. Please be advised that payment is due at the time of service and we will be collecting [an estimated $xx.xx] upon your check in. Do you have any questions?”

6. Waiving co-payments or late fees.

You cannot and should not waive co-pays at any time. Regarding late fees, you may choose to waive a late fee if there are extenuating circumstances. If you never plan to use co-pays, however, get rid of your policy. If you never enforce the policy, patients will not take it seriously and their bad behavior will continue.

7. Patients who promise to pay a bill on a certain day but don’t follow through on that promise.

Unfortunately, verbal (and even written) promises to pay may just be methods patients use to buy time. Sometimes this is an intentional tactic and sometimes it is true hardship. The best protection is to develop a collection process (write it down), adhere to it, be persistent, track results and fine-tune the process as needed. The longer a bill goes unpaid, the less likelihood you will collect it at all.

In Summary

· Create a strong financial policy, educate patients about it and stick with it.

· Remind patients of financial responsibilities upfront. Keep them informed.

· Make it clear you expect payment when payment is due.

· Develop scripted responses for recurrent problematic situations.

· Both doctors and staff need to be on the same page with predetermined, strategic responses.