I’m bored!  I hate being retired.  Many of you have called to let me know how frustrating it is to find a new doc.  Apparently, many of the practices in our area are closed to new patients.  There is a growing shortage of generalist, family physicians and internist in our country. My sudden retirement has made that shortage readily apparent in the northwest suburbs of Chicago.  

Today, while cleaning up some old files, I came across this article.  Family practices across the US are disappearing.  Reimbursements are dismal and expenses continue to rise.  While I miss seeing my patients, I am happy to be rid of the hassles and disappointment associated with billing and collections.  Doctors are not paid for their services.  Doctors are reimbursed by an insurer at an ever-decreasing rate at some time in the future.

Your physician is not raking in the money!  In all probability he/she is struggling to keep his/her practice a float.  I know that sounds ludicrous, but I assure you it’s true!  The private practice of medicine is financially non-viable.

In a world where 20% tips are often added to your restaurant tab, where you tip the garbage man at Christmas, your hair dresser and just about every one else who provides you with a service, you don’t tip the one person who works to keep you healthy and treats you when you are sick.  I’m going to catch a lot of shit for printing this but perhaps you should consider tipping your doc.  The odds are he won’t take it, but I bet he goes home feeling truly appreciated.

Remember Dr. P.  Dr. P. and I practiced in a time when patients paid in cash, brought presents to the office (usually food) and appreciated our care.  Of course, as we actually got paid for our services, rates were much lower.  Sports physicals were $5 a child when I first started in practice.  A visit for a sore throat was less than today’s copay.

Then, everything went haywire and the insurers dismantled and destroyed a beautiful thing.  Unfortunately, the article I wrote in 2013 is even more pertinent today.  You can help.  How? Read on.

July, 2013

“Doc, it’s only $10. I can’t believe you’re throwing me out of the practice for a measly $10. You, docs, are all the same. It’s all about the money!” Unfortunately, the money is important. It costs money to keep a practice running. It costs money just to collect the money owed to the practice. Sometimes, it’s not only $10; tonight’s was only $100! My question is always the same: if it is only $10, $20, or even only $100, why not pay it when the bill comes?

The answer is often the same, “My spouse pays the bills. This letter terminating our relationship is the first I’ve received. If I had known I owed you money, I would have paid.”

So, let’s look at some simple facts. Your physician’s office is one of the few places where you can receive advice, services, and materials without payment at the time of receiving them. Can you imagine leaving Jewel without paying for your groceries or picking up your car from the mechanic without settling the bill? Of course not!

Once your physician cares for you or your family, his billing department (yes, department, it takes many employees to process and bill for his services) sends your bill to your insurance companies. Your physician then waits for his reimbursement and for your insurer to decide what portion of the charges you are responsible for.

Once your responsibilities are determined, a billing clerk sends you bill number one. I’m sad to say only thirty percent of patients pay bill number one. The other seventy percent receive bill number two. When bill number two is going out, my staff makes a call.

“Mr. ‘X’, this is a courtesy call to let you know that you have a balance of $xxx. Would you like to pay by credit card now? No? You will receive another statement in the mail shortly and we would appreciate your sending payment. We will be glad to work with you.” Very often, messages must be left asking our patients to return our calls and they never do make these return calls.

When the bill still hasn’t been paid by the time the third bill cycle comes around, the billing clerk makes another phone call similar to the one before trying to make payment arrangements that are comfortable for the patient. We know these are hard times for many people and we want to know what is comfortable for you. All we ask is that you make a commitment to pay your balance and then honor this commitment each month. We ask for you to communicate with our billing staff, not ignore them. The balance will not go away. They will help you!

After the billing department has had to send out three billing statements and make multiple phone calls, this patient has added to your physician’s overhead and the bill is still there. Finally, after months of continuing to “care” for you while you continue not to pay your balance, we turn your account over to the first level of collection. At this stage, we still will see you as a patient while you are receiving letters from the collection company; and we are hoping that you will pay your bill and all will return to normal.

There are many opportunities, even at this point, to settle the account and make payment arrangements. It just takes communication and desire. However, if you do nothing and this first part of the collection process runs its course, the final step occurs. The patient is sent a certified, return receipt letter, along with an identical first-class letter, informing him that he has been discharged from the practice. 

It is, at this point, that the patient who has “never received any bills” shows up. The patient is irate! It’s only $100. “Doc, you need to take a lesson in caring! It’s all about the money, isn’t it?” Funny, the termination letter was sent to the same address as every other statement, collection letter, and bill; and it was received!

Meanwhile, 100 patients who refuse to pay the seemingly trivial amount of $10 they owe cost the practice $1000. You do the math. It adds up to a lot of money. It may sound strange to you but $10 is a significant amount of money to your family doc. Your family doc doesn’t have any high-priced procedures to pay the bills with. Your family doc needs the copay and needs you to take care of the bill that you generated when he took care of you. Also, keep in mind, that the $10 you don’t pay doesn’t take into account how much it costs us to re-bill you two and three times.

I am going to repeat this. We know times are hard. Talk to my staff. They will work with you. If you get a statement and you think there is an error, call immediately. Maybe there is an error. Help my staff fix it. Don’t wait until it is too late to refile or fix a claim. If the statement is correct but you can’t pay the balance, be honest and set up a payment plan. Just make the promise and carry through monthly. By being honest with your doc, you can help lower his overhead and preserve your relationship. By avoiding the subject and not responding to your debt, you leave the impression that you do not value your doctor’s care and his staff. 

Remember Maki’s favorite line, “Help me help you.” Help us help you by paying your first bill or letting the billing staff know what’s going on. Do not rely on your spouse to pay the bill: it’s your debt, your relationship with the doc, and your responsibility.

One last piece of advice. When you’ve ignored the bill or waited too long to address it, don’t be threatening, belligerent, or insulting. Take responsibility, pay the bill, and write an apology. Maybe you can salvage the relationship; maybe you can’t. A simple “I’m sorry, times have been tough” goes a long way.

So, why am I writing this series of articles.  Medicine should have never become a business.  It has been and always should be the calling that brought me to Lake Zurich.  Those dinosaur-like physicians who struggle to stay in independent practice need help.  They can’t tell you that they need help.  Our profession is a proud one despite everything that has happened to us and very few of us will tell you the truth.

I can.  I’m retired and old enough to speak my mind.  

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