Friday, July 3, 2009

Should You Send a Bill after a Patient Dies?


I logged onto a physician forum website and came across the question; "Do you charge an uninsured man's family after he dies?" The patient was in the hospital for a month and the doctor cared for him daily. The man was not insured but the patient's finances are enough to pay cash for the entire hospitalization. The doctor questions if he should bill the family after the patient died?

My first though was "No, just absorb the losses. The situation is unfortunate and the family will have enough problems without receiving doctor bills." As I read the comments on the site however, I realized no one else thought that way, and in fact, I could see the wisdom of the replies.

Most comments were something like, "You provided service and you should be compensated". Or "We all have bills to pay and they sure seek me out when I owe them - the lawyer, the credit cards, even the grocery store." Or "If the plumbing stopped up at the man's house while he was in the hospital, would his family NOT be expected to pay it?" Or "Absolutely send a bill. You can be sure the funeral home, the car dealer, the mortgage company, the magazine subscription, the credit card companies are all sending bills every month." Or "When will physicians realize that medicine is a business? Bill the estate the entire amount due." Or "Beware of the doctor who does not charge. He knows the value of his services."

There were 116 comments and about 99% of them felt a bill should be sent. Some advised a sympathy note also and some said the bill would likely not be paid. Only 2 out of the 116 suggested he not bill the estate.

After reading the comments, I re-thought about my gut response. I think he should bill, but should not actively pursue collections if the family/estate does not pay. We all do charity work, and this may just need to be written off. Of course, that may be one reason why primary care doctors are going the way of the dinosaur.

13 comments:

Anonymous said...

Are all these commments on that site from doctors since it is a doctors forum?

Toni Brayer MD said...

Anon: yes

Beverly said...

I don't know how valid my opinion is, but I have heard that family is not legally responsible to pay bills for a deceased family member or parent. I think there is a moral obligation to pay the doctor however.

The Happy Hospitalist said...

Does the funeral home collect when their client dies? I even saw a funeral home take a family to court when they wouldn't pay. Saw it on one of those TV judge shows.

KM said...

If the death couldn't be helped and everything was done right I think then the doctor should be paid. But not if the doctor was part of the problem or his or her treatment or lack of was the reason for the outcome, in that kind of situation I think he or she should not be paid.

Anonymous said...

The "family" might not have a legal obligation to pay the bills, but the decedent estate generally does, and the two are not the same. This is the assigned responsibility of the named executor as long as the estate has the resources to satisfy the outstanding obligations.

Just because you die doesn't mean all claims against your estate are forfeit.

And to add to the discussion, I certainly would bill the estate for my services.

This is also the reason there are probate courts.

Anonymous said...

"KM said...
If the death couldn't be helped and everything was done right I think then the doctor should be paid. But not if the doctor was part of the problem or his or her treatment or lack of was the reason for the outcome, in that kind of situation I think he or she should not be paid."

And just who decides those factors?

KM said...

Anon: July 10 7:10 PM
Good physicians who practice ethically, know what high quality of medical care is, have knowledge of what the gold standerd of practice is that is supposed to be done. These doctors "should decide those factors". Like the example of the surgical operating team having a check off list similar to a philot does to avoid and prevent errors. A physician should give the same kind of medical care they would want to recieve for themselves. The ones I have seen who do this tend to be the best doctors. Those doctors should be paid and would recognize the cases when other physician should be paid or not, they would recognize when deadly mistakes were made or not. Like the peer review board that reviews questional cases. Same as coroners knowing the true story of what really heppened.

Jenn said...

I think a bigger question that needs to be raised is "should Dr's reccommend aggressive treatment when they know the chance of death is extremely high?"

My grandmother's personal physician was aghast when he found out that the hospital oncologist was telling her/my family that she could live for another 6 months if surgery was consented to. He said that there was no way she would live that long, all surgery would do would make her remaining days more expensive and painful. While she was 79 and still living independently when she went into the hospital for stomach pain, she lived less than a week after the oncologist had first reccommended surgery for pancreatic cancer--her death came two weeks after going into the hospital. If she was so ill that she died that quickly, would she have really tolerated surgery well enough to live another 6 months?

My father-in-law was encouraged to consent to aggressive chemotherapy for stomach cancer even though the American Cancer Society website said that the 5 year survival rate was only 5%. His Dr's never told him that--only that if he would just try this, that, or the other treatment he might just beat the cancer. He lived for 3 miserable years after the diagnosis, and my mother-in-law stopped adding up the medical bills (all went to Medicaid) when they hit $800,000. I would not be surprised if his bills exceeded $1 million...and...well...he didn't earn that much money in his entire lifetime.

We simply can not sustain this kind of spending. At some point we need to say that just because we *have* the technology, doesn't mean it is a good idea to use it.

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