Monday, September 10, 2007

Primary Care Doomed - what does it take to get paid?

Most primary care doctors are running a small "mom and pop" business and any business will fail if payment is not received. A review of "ageing reports" (accounts receivable) can be eye opening for the doctor. Thirty-60-90 days past due can be a financial disaster. But what about bills that are not paid for over a year? It is not uncommon for active patients who get prompt return phone calls, easy access when needed and seem to be very happy with the service to just ignore the bill.

Seeing this list of patients who just won't pay their bill is usually a shock for the doctor. All of these statements were first sent to insurance companies. The insurers delayed as long as possible (60 days or more) and either made a partial payment or paid zero because it was applied to the patient's deductible, or the patient wasn't even insured at that time.

The patient received an explanation of benefits (payment or lack of payment) from their insurer at the same time the medical office received it. Bills are then sent to the patient for the balance due. Most billing services (which is part of the doctors' exorbitant overhead) sends a statement month after month after month. It is a rare doctor who would send someone to collections.

These amounts are small for a general internist. The amounts due range from $21 to $455 (that is obviously multiple visits over time). When physicians see a patient, they do not usually know their account status. A good doctor DOESN'T WANT to know and that may be one reason many primary care physicians are struggling financially.

Available primary care physicians are few and far between. Many are not accepting new patients . I am asked for referrals all the time and I am hard pressed to know who would take a new patient. In the San Francisco Bay area, fewer and fewer primary care doctors are accepting insurance, but instead are asking for payment at the time of service. As others start looking at their accounts receivable, they will be doing the same.

9 comments:

Anonymous said...

Maybe it's time the free ride ended for those who are abusers anyway.

Anonymous said...

Maybe it's time the free ride ended for those who are abusers anyway.

Linda Cole Leighton said...

How sad that people are so irresponsible! Don't people realize that the doctors have to pay their bills too? I can not imagine doing anything so unconscionable.

Toni Brayer MD said...

The crazy thing is that the "deadbeats" are often financially well off...it seems they are just careless about doctor bills.

Rich said...

Unpaid medical bills don't go on your credit history. maybe if they did things would change.

Raymond Bouchayer said...

Doctors have to be paid their fees without discount promptly .
This should be done by a National Heath care system like England-France and other countries. It is paid by their taxes.
Any other system invites greed and huge profit to the Insurance and drug companies and with Insurance premium that millions of American cannot afford. Wake up fools ! we are all been fleeced .

Mark said...

In Australia you see a specialist and they swipe your credit card on the way out. THat's all folks.

Toni Brayer MD said...

Mark, that makes so much sense. Music to this doctor's ears!

Rich said...

In our office, the patient's balance is now printed on the top of the blank form we use to track care we provide. It's a form printed new for each visit, so the balance is up-to-date with each visit. I rarely comment on it to the patient, except if it's very large, old, or growing... then I ask how we can help. Often they're embarrassed when I ask, and make arrangements to pay it as they check out.
I think more doctors will also be requiring payment at the time of service, and give the paperwork to the patients to file with their insurance companies to get reimbursed. Think medical care is confusing enough to patients... it won't get better...