This original article was featured in the November 2021 issue of Chiropractic Economics

Do you know what one of the main triggers for complaints filed against doctors to their state board is?  Disagreements over money  – specifically when it comes to amounts expected for a refund..  

We all hate it… That moment when talking about money with a patient goes from awkward to just plain bad. It’s a very common situation for people to be uncomfortable when it comes to talking about money with their patients. Then, there are some scenarios, like trying to collect on an old balance due, that we just dread. 

It doesn’t have to be uncomfortable or awkward, and you don’t have to feel “pushy” either. In fact, many of the situations that offices find themselves in can very easily be minimized or avoided altogether. 

Before we dive in, I want to bring up a key piece of advice to keep in mind as we go through these situations.  My advice?  There may be a time where it’s best to just forgive a balance due or give the patient what they want, like a refund.  I know this advice can be frustrating because you did your job and you deserve to be paid for it! In some scenarios though, it’s better for you in the long run. Here’s a good example: 

A few years back, a doctor who was not a client of mine reached out to me desperate for advice. This doctor explained to me that he was going to court to defend himself and his practice. He estimated that he had spent about $70,000 in legal fees. Should he lose, he was in jeopardy of a $20,000 fine and two year probation. The cause for all of this trouble? It all started regarding a patient whose money he would not refund. The refund amount would have only cost this doctor a few thousand dollars.

Because this doctor didn’t have the proper financial policies and procedures in place, there was a misunderstanding that led to thousands of dollars spent, countless hours of stress, and this doctor now hating practice. 

I’m not saying this to scare you, but to empower you. If you have found yourself in a situation where it may just be cheaper to refund the patient or forgive a balance due, do it! Then, apply the changes I’m going to teach you right now so that it doesn’t happen again.  

Let’s review some other situations and I will explain how to handle them, and better yet, how to avoid them in the future: 

Scenario 1: The patient ended care early and there’s a balance due.

How to resolve: This is a common problem that I hear a lot. The patient has ended care early and they do not understand that there may be a balance due. Assuming you have some sort of agreement that the patient signed at the beginning of care, the first thing I recommend doing is calmly and politely referencing that and explaining how and why the balance is due. It usually breaks down to X amount of care was received, and only Y amount was collected in payments. 

If you don’t have any documentation like the one above, you can try to explain it to the patient by showing how much care they have used vs. how much they have paid, while supporting this with a printed statement. 

When asking for payments, make it easy for patients to pay you! Email or text them a link so they can make the payment directly to you. Do not make them cut a check and mail it in– make their payments frictionless!

If this doesn’t work, you can try to send them to collections… However, I personally am not the biggest fan of this for several reasons. This can be a tedious, expensive, stressful process and it 100% guarantees that those patients will never be back.  Not only that, they’ll talk negatively about you and your practice and you don’t want that.   

If you’re still not able to collect on the balance due, consider just letting it go. Make diligent notes on your efforts to collect the remaining balance. 

How to avoid – The best way to avoid this scenario is to clearly explain how care is calculated and how it is determined, right from the beginning when they are agreeing to care. Present your care plan to the patient and make sure that you have a page that clearly explains what happens in this scenario. 

When presenting this to the patient, I like to make it extra clear so I will say something like, “Mary, one of the most common questions we get about these plans is what if you have to stop the program early? You should be aware that you have the right to stop at any time. You are

not locked into this. All we do if someone stops care early is we go back and prorate the plan for the care you’ve used. If you’ve paid more than that amount, we refund you the difference. If you’ve paid us less than that amount, you would pay us. If you’ve paid more than that, you will get a refund.”

Also outlined in the terms that I mention when speaking to the patient is a section that says if there is a balance due, I will charge their card that I have stored on file. They are authorizing that right then and there! Now, I still recommend that you notify the patient before you charge that, but having that agreement there protects you. 

Scenario 2: The patient can’t pay due to financial hardship.

How to resolve: We never want the inability to pay to be an issue for the patient and stop them from receiving the care they want and need. To help them in this situation, it requires having a candid conversation to see what you can do to work with them. If they still want to receive care, work on a monthly payment plan that incorporates their balance due as well as their care going forward. 

If you’re presenting a plan for care to a new patient and they say “no” due to not being able to afford it, I have a strategy to address this. Rather than reducing your recommended care, I recommend adding in some wellness visits and extending the period of time. You aren’t recommending care that they don’t need, you’re simply adding in the next phase of care. Since it’s less frequent towards the end of care and spread out over a longer period of time, it actually brings the monthly payment down.      

If they are no longer going to be receiving care and there is a balance due, offer to work out a monthly payment plan to pay off their balance. 

In either of these situations, you may also see if this individual can fall under your financial hardship policy. It needs to be evaluated periodically to make sure they still fall under that category. A good resource for a Hardship Policy is KMC University.  

How to Avoid:  From the get-go, I would put them on a care plan with a monthly payment that they agree to and will work for them. This makes care affordable for the average person with or without insurance. 

To help with this even more, I recommend incorporating a Discount Medical Plan Organization like ChiroHealthUSA. This will help make care affordable for those that don’t have insurance or are under-insured. If you accept insurance, it’s even better because you can set your fees higher to maximize insurance reimbursements.  You can also then discount more than 15% to make care affordable for any non-covered services.  

Your patients being in financial hardship is hard to completely avoid because things come up in peoples’ lives. The best we can do is try to be there for them and make it work for them, while also making sure you have the proper policies and procedures in place (example: financial hardship policy). 

Scenario 3: The patient says no to purchasing more care.

How to resolve: First, you need to determine why the patient is saying no. It’s very important to get the patient to agree to the time and frequency of care before they agree to any sort of money aspect. Determine if the “no” is to money, to time, to the care itself, or to some other challenge. This can be done by simply asking the patient. 

If someone is on a block of care in this scenario, that needs to be addressed right away. Only people that can’t physically show up in the office on a regular basis are people who should be on blocks of care. And what are two of the most common reasons people don’t continue on with more care?  They don’t know where the care is going and they feel like they’ll always just be asked to purchase more blocks care, while the other reason is that the care isn’t affordable. To resolve this right away, stop putting people on blocks of care that shouldn’t be on them. 

Now, take this patient that said no and recommend a program of care that begins with the end in mind and allows them easy payment options.  Let them know right away how many visits you will be recommending to resolve their challenges and how long it will take. This helps people to not feel “sold” and think there is no end in sight every time you ask them to repurchase again. They know right away roughly how many visits they will need and the bonus is that you are splitting this up with easy payment options to make it more affordable. 

I usually say something like, “Susie, once we have corrected the cause of what’s going on, I’ll only need to see you a few times a month to maintain the work we did. But to get there, I’m going to need to see you X times a week for a while, and then we can taper off…”. From there, I would discuss how many visits and how long care will be. 

To resolve this challenge, we need to immediately start removing the opportunities for the patient to question whether they should continue or stop care. That means we need to put them on an all-inclusive program of care right away. Patients like it because there are no surprises, and you like it because you don’t have to continually ask them to re-sign or sell them more care. 

Related: The Patient Journey: Patients Get The Best Results When They Follow Through

If the patient is saying “no” to continuing care due to the challenge of money, refer to the strategies in the previous step. 

How to Avoid: To avoid this in the long run, employing the above strategies of forecasting care and giving affordable payment options that remove the thought of money right at the beginning of care will set them up for success. You will be removing the opportunities for them to say “no” in the first place. 

Talking about money doesn’t have to be awkward or uncomfortable and sometimes it just is. However, the best we can do is to reduce the need for those situations to come up in general. If we meet the patients where they are with empathy and solutions, we can help them to receive care and avoid a large amount of outstanding balances. 

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