The Struggles of Getting Patients to Pay

By: Deborah Winiger, MD

One of the most difficult issues in healthcare today with payment is the shift in payer responsibilities from the insurer to the patient. Patients are now responsible for larger portions of their medical bills and most don’t understand their plans. My staff has spent more and more time explaining insurance explanation of benefits to patients and helping them understand that payment is their responsibility.

More and more patients are being sent to collections due to failure to pay. I try to stay clear of the discussions to separate patient care from billing, but lately I have had to get more involved. Patients have made personal attacks on me and my staff as if we did something wrong that justifies them not having to pay. Recently, a patient decided that she thought she would pay what she thought was “fair” even though the insurance approved and processed our claims. Patients have also told me they didn’t want to pay since we had a consultation but didn’t prescribe medication. My staff and I do things every day that we aren’t reimbursed for but patients still complain about paying when they do come in.

We have tried multiple strategies to collect better. We now try to run eligibility and check deductibles and coinsurances prior to visits, and then collect patient portions at the time of the visit. This is definitely a culture change for patients - some are very accepting and understand, but most challenge it. We have also instituted service charges for small balances under $30 which aren’t paid within 30 days -it has helped some but we are still posting many service charges. We were spending so much money on sending out statements for small balances multiple times or just waiting until the patient comes in to the office that we were trying to streamline the process. I am always looking for ways to help collect better and love to hear what other practices are doing.

I prefer to spend my time with patients and developing relationships, but so much time is spent on these issues it takes away from the parts of medicine we all enjoy. It would also be helpful if insurance companies would educate their patients better and not tell patients to have us change coding to get paid when we have coded correctly. Patients expect us to know their plans. I have learned more about insurance than I would ever hope. Hopefully as this trend continues patient will become more educated and be more willing to pay their portion without a fight.