Photo Credit: Julia Manga

Patients that struggle to pay their medical bills can be a financial burden for physicians, but there are strategies patients can learn to stay on top of their medical bills.

Unfortunately, most physicians encounter patients who refuse to pay their medical bills. According to medical writer Kristen Fuller, MD, these patients may be either self-paying or insured. Either way, they avoid paying out-of-pocket expenses. Healthcare-industry veteran Hanny Freiwat studied collection rates from insured patients versus those from uninsured patients and found that the former ranged from 50%-70% following medical care. For the latter, however, collection rates following medical care reached a nadir of 10%.

Dr. Fuller notes that patients that are self-paid may be either uninsured or committed to payments not related to their insurance plans, adding that uninsured self-paid patients are becoming more common due to rising insurance deductibles. Paying their physician themselves, as opposed to relying on a third party to manage the transaction, might make payments both more affordable and more attainable, given that a large group of patients may struggle to pay their deductibles. What’s more, insurance company rates are frequently higher than the amount of cash patients pay directly to physicians for their services—an amount that physicians determine.

While self-paying would be ideal in a vacuum, external factors concerning the business-of-medicine can hinder its full potential. According to Dr. Fuller, physicians would be best served to have a clear, formal written policy in place-with an detailed index of services and prices-when it comes to patients that are self-paid, thereby ensuring patients are aware that their payments are due upon service. Physicians could send this payment policy through email or text, to be signed at the initial visit. Dr. Fuller advises physicians to be sure that new patients are aware of the payment policy, including the amount of a patient’s first visit. Furthermore, physicians need to be mindful of informing patients of any treatment, prescription, or service payments for which they will be financially responsible. Checking all these boxes will yield a greater likelihood that self-paid patients will indeed pay their bills. Dr. Fuller suggests using payment-policy wording like, “Patients who do not have insurance are responsible for the entire amount of their bill,” and “Patients with insurance are responsible for any amounts their insurance does not cover, up to the entire amount of the bill.”

Nonetheless, some patients simply may not have the funds to provide their entire payment upon service. According to Dr. Fuller, physicians facing this situation may either opt not to treat the patient or to instill a payment plan. If the physician moves forward with a payment plan, they should make sure it is specific and thorough, including a pre-service promissory note, clear due dates, exact amounts to be paid, and a substantial down-payment. Dr. Fuller notes that although payment plans may add to the tedium many with which office staff may have to contend, physicians may ultimately draw in a wider patient population, thereby increasing revenue. When it comes to insured patients that are self-paid, Dr. Fuller advises physicians to be aware of any required copayment, deductibles, or possible out-of-pocket expenses, encouraging them to always obtain all of the copay upon service. Physicians should also try to secure as much as they can of the estimated deductible and coinsurance.

While it may be tempting to dismiss patients who haven’t paid, Dr. Fuller suggests trying a few strategies first. For example, the physician’s staff could contact the patient, engaging in a non-intimidating honest conversation to try to find a way for the physician to get paid. If this doesn’t work, or if the patient is entirely unreachable, Dr. Fuller suggests sending the patient a letter via email, snail mail, or the patient portal. If after all these efforts, the patient still doesn’t pay, the physician should send the bill to collections and dismiss the patient via a certified letter, requesting a return receipt. Dr. Fuller notes that physicians should provide dismissed patients with at least one month of time to find new medical care.