Medicare Compliance & Reimbursement

Experts: Give patients a few chances to pay, then call collections.

Copays are standard for most patients, but what happens when a patient refuses to pay it? Though this kind of behavior is rare, it can happen and you need a clear policy on how to handle copay conflict.

The problem: If you cannot defuse the situation quickly, things can turn ugly fast — and it will likely play out within earshot of other patients.

Check out this expert advice on dealing with patients who are outright refusing copayment.

Step 1: De-escalate the Situation

When a patient makes it clear that he has no intention of paying his bill, you should not refuse service at that time, experts say. Let the patient see the physician for his scheduled appointment, and make sure you don’t antagonize the patient or get argumentative.

“We don’t get confrontational [with the patient],” says James P. Bartley, MS, Med, a practice administrator in Norwalk, Conn. “I’m not going to get into an argument with a patient over a $20 copay.”

Do this: Remind the patient of the financial responsibility agreement he signed (if the practice has one). Then, Bartley recommends gently telling the patient “If you don’t want to pay it, it’s understandable. In the future, we’re not going to book you an appointment unless the balance is taken care of.”

Step 2: Follow Up With Statements, Phone Calls

After the noncompliant patient leaves the office, you should note in his file that he hasn’t paid. Then, continue your collection efforts for a couple months. The individual practice must decide how long it wants to try to collect from the patient, but most experts recommend a combination of phone calls and letters for a maximum of three months.

It can be too costly for a practice to continue collection efforts after three months, so once you pass the three-month point, it’s typically too labor-intensive to chase money.

Exception: If your practice uses a billing company, then it will make the decision as to how to collect the outstanding copay.

Step 3: Call the Collectors

The absolute last option is handing the matter over to a collection agency. The agencies are a last resort because “obviously you’re going to take a financial hit” from paying the collectors, Bartley explains.

When you turn the matter over to collectors, it might also be the start of the end of your practice’s relationship with the patient.

Step 4: Send Termination of Service Letter

If you decide to terminate your relationship with the patient, cover your bases by getting it in writing.

Do this: Send the patient a certified letter with signature confirmation that informs the patient that you are terminating future care of the patient with your practice for failure to pay financial obligations. The termination letter should also clearly request the name of the physician the patient will continue care with so you can forward the patient’s medical records to his new physician.

Tip: You should also include a “one last visit” clause in the certified letter. This clause should clearly state that if the patient is in need of medical care and doesn’t have a new physician to continue his/her care, then the practice will see him one last time before severing patient care.