Q&A: What to do when a patient refuses to accept a dismissal

March 6, 2009
Judy Bee
Judy Bee

The author, a practice management consultant with Practice Performance Group in La Jolla, CA, is an editorial consultant to <i>Medical Economics</i>.

I have a patient with a high-deductible plan who doesn't want to pay for his visits. I've sent certified letters to dismiss him, but he doesn't accept the letters.

Q: I have a patient with a high-deductible plan who doesn't want to pay for his visits. I've sent certified letters to dismiss him, but he doesn't accept the letters. He comes to the office, but can I refuse to see him until he pays? Or can I hold his prescription until the balance is taken care of? Since I'm unable to dismiss him with a letter, can I do it in the office with a staff member as a witness?

A: If your patient is being that noncompliant, you are right to want to discharge him. First, call your attorney and ask her to send the discharge notification in the law firm's branded envelope. Ask the attorney if you must have the patient's signature or just proof of delivery, because you may not need the signature.

Next, either send the account to collections or, if the balance is large enough, have the attorney collect it for you for a fee. Sometimes that is more effective with high balances and sophisticated patients. You cannot withhold records, and you cannot refuse to see him unless you have notified him of discharge.

Send your practice management questions to mepractice@advanstar.com (please include your regular postal address). Answers to our readers' questions were provided by Judy Bee of Practice Performance Group in La Jolla, California; Keith Borglum, CHBC, of Professional Management and Marketing in Santa Rosa, California; and Alice G. Gosfield, JD, of Alice G. Gosfield and Associates in Philadelphia.