# Discharging patients with large account balances



## lbristol (Jan 4, 2013)

Does anyone happen to know what the laws are in regards to discharging patients with large balances? I am in internal medicine and we have patients who require maintenance/narcotic medications, needing to be seen every few months. For the patients who have large balances and are not willing to pay, is it illegal to discharge them from the practice? Where can I find reliable literature on the topic? Thanks for any input!


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## dclark7 (Jan 4, 2013)

No it is not illegal to discharge patients.  You should send a letter certified mail with return receipt requested (I also send one regular mail in case they refuse the certified letter, if it's not returned you can assume they received it).  The best thing to do is check with your malpractice insurer, they may have sample letters you can use.  You should also check to see if your state has any regulations regarding this such as how much notice you have to give to the patient (30 days is usually sufficient, but states may vary).

I would not state in the letter that you are discharging them for financial reasons, the physicians I used to work for simply stated that the relationship had become unsustainable.  We also included in the letter a list of physicians in the area and phone numbers.  You also need to be careful of what you say if another office calls to find out why you discharged the patient.


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## Bready (Jan 4, 2013)

*discharging patients*

The AMA has some guidelines for that and you should check with them but a few that I remember from the top of my head:

notice is given in writing on why patient is being terminated from your care, patient is given at least 30 days notice(and physician continues to see patient for that 30 day period and give meds if needed), patient is given options--names of other physicians who can treat the illness  and/or name of clinic that he/she can go to, and lastly, letter is sent certified.


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## lbristol (Jan 4, 2013)

Thank You! This has been very helpful!


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## jennifermapple@hotmail.com (Feb 8, 2013)

*Certified Dismissal Letter question*

Does the certified letter have to be signed by the patient? Is it necessary to have a copy of either the signed letter or the signed certified green card showing receipt of the letter?


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