Practice Management Alert

You can control the conversation and get better payment results if you're prepared with the right responses

When patients with past-due accounts say they can't afford the bill or don't know anything about it, you need to react quickly to maintain control of the collection call.

Depending on how extensive your in-house collections efforts are, you may encounter many reasons why patients say they can't pay their bill immediately. Check out these two common patient excuses and reap the benefit of our experts' collection call advice.

Patient excuse #1: "My wife always does the bills and takes care of our finances, and she's at work. I don't know anything about this bill, so I can't help you."

Best answer: Pointing to a spouse is often a stall tactic, says Gary Kinne, president of Asset Recovery Inc. in Rutland, Vt. Make the most of a stalling spouse with two easy steps:
 
1. Ask for the spouse's work number. In case the unavailable spouse is truly the better party to speak with about resolving a debt, you should first try asking for her work number. Try a well-crafted request like this, says James Christensen, MCE, president of JC Christensen & Associates in Sauk Rapids, Minn.:

"Mr. Johnson, your wife takes care of the bills - I understand that. And you tell me I need to talk with her. I'm very willing to do that, but in order to do that I need you to assist me, and that would mean I need to get her number at work."

If Mr. Johnson says his wife cannot have calls at work, you know to stop this pursuit immediately and move on to the next step, Christensen says.
 
2. Enlist the stalling spouse's help. You might continue the conversation like this, Christensen says: "Mr. Johnson, I can appreciate that your wife handles the bills, but understand that you are responsible for this debt as well - and you and I together need to get this resolved."

Tactic: "Create some urgency" by asking what time the working spouse will get home, Kinne says. Then either you can ask Mr. Johnson to have his wife call your office when she gets home, or you can arrange to call back in the evening when she will be available, he adds.

Another way: Instead of simply asking Mr. Johnson to have his wife be in touch by the next day (which may never happen), create a sense of obligation and responsibility in Mr. Johnson by making him the middleman between you and his wife. Come to an agreement in which you say Mr. Johnson should speak with his wife, arrive at a fair and feasible payment plan, and contact you in the morning, Christensen says. Be sure you specify a date and time and be clear that you need Mr. Johnson to call you back by then, he adds.

Patient excuse #2: "I lost my job, so I don't have any money to pay that bill."

Best answer: The best way to proceed is to gather as much information as possible about the consumer's situation and get an idea of whether he can truly afford to start paying immediately. Use the "psychological pause" after every question or statement you make to compel the patient to respond with the information you seek, Christensen says. Ask the following expert questions to find out everything you need to know:

1. Where were you employed? If the patient refuses to say, take time to explain why you need this information. For instance, you might say, "OK, help me understand this, Mr. Johnson. You're unemployed and you want me to wait for you to pay your medical bill, but you don't want to tell me where you were employed ..." Draw out your explanation to emphasize the patient's lack of cooperation, Christensen says.
 
2. What was your position? A quick, clear answer tells you the patient is telling the truth and not scrambling for a lie. If you sense the patient is just making up excuses, you'll know this account is a likely candidate for your third-party collector.
 
3. Is there another breadwinner in your household? This information helps to complete your picture of the patient's financial situation. If you know the patient has a spouse, ask where the spouse works - never if the spouse has a job, Christensen says. Asking where implies you have knowledge that he does work and is more likely to elicit a true answer.

With experience, you should be able to pick up on the details of what the patient is telling you and come up with a ballpark estimate of the household's earnings - based on the patient's employment status and the spouse's profession.
 
4. How long have you been unemployed? The answer to this often-neglected question can instantly tell you whether unemployment is the real payment issue, Christensen says. If the account is 120 days old and the consumer just lost his job, ask him why he didn't pay it when he was working, Kinne says.

Also consider: Some professions are seasonal, such as construction. So the consumer may be currently unemployed but may also have anticipated this period of unemployment and already earned his entire year's salary, Christensen says.