In my last blog post, I mentioned a new financial policy we implemented in an effort to curb the growing trend of bad debt write off as a result of the economy and the rising cost of health care benefits.
Today, I wanted to continue the same topic and address some of the customer service challenges we’ve had and how we’ve dealt with parent’s concerns.
How has it been so far?
It has been 3-months since we’ve put our policy in place and I’m happy to report that the vast majority of patients haven’t even blinked at the credit card requirement. The front desk reports occasional issues with parents. Most parents with concerns pout, but they end up handing over the card. Quite frankly, I was prepared to have more families upset and leave the practice. But I’m happy to report that only 4 families have left so far (that we know of). That is pretty good considering we have over 3000 families visit our office in a given year.
Not to say we haven’t had complaints and customer service issues. I’ve kept track of some of my parent encounters and I found that around six families came around after I explained and addressed their concerns. They understood the policy and felt comfortable leaving the card on file once they talked to me.
Four families said they would think about it and decided to “weigh their options.” These parents said they loved our doc’s and they understood why we had to implement such a policy, but didn’t know if leaving a credit card on file was worth it for them. In other words, they felt that it was too much of a risk versus the value we provided (Ouch!).
Five families decided to leave the practice altogether because they didn’t like the policy even after I talked to them personally. However, one of those families already has come back to the practice and agreed to the new policy. So I guess that makes only four families that have left as a result.
Of course I only know about those that expressed concern and discontent. I’m sure there were those that were unhappy and left without a fight or voicing their concerns. Nothing I can do about that.
Below are some of the concerns, issues, questions that parents had once they found out about our credit card policy. I’ve also included our thoughts and comments behind our parents issues.
Are you denying care for my child?
We would never deny care to a patient that is sick. If a patient is sick and her parent refuses to comply with the credit card policy, we advise the parent that we will happily treat the patient’s condition, stabilize it or resolve it altogether first. Moreover, we let the parent know we will continue to treat the patient for emergencies ONLY during the next 30-days, but once the 30-days lapse from the date of service, the patient will be dismissed from the practice.
If we find that a parent has not been properly informed before the date of service either because they never received a statement or letter, we explain that we will see the patient for that day and agree to see the patient for emergency visits only during the next 30-days.
If a parent brings in their child for a well-visit and they have been informed of the policy in the past, yet they still wish to receive services, but refuse to acknowledge and sign the policy, we do deny care.
What about identity theft and privacy?
This is the number one concern and it is a legitimate concern. We tell parents that under HIPAA, we are under strict rules and guidelines in terms of protecting patient privacy and the credit card is considered protected health information. We also let them know that because of HIPAA rules, medical facilities are far more secure than most retail establishments as it relates to identity theft.
Secondly, we tell parents that we already store sensitive information. We have their DOB, home address, employer, SS, how many kids they have, home numbers, cell phone numbers and emergency contact numbers, all of which are highly sensitive. So if they didn’t have privacy concern before, then there isn’t a reason for concern now.
Lastly we point out that when they use their credit card at a restaurant, the server disappears for 10-minutes, and then comes back with their card. Nobody has an idea what the server did with their card. But nobody thinks twice about handing over a credit card to a stranger at a restaurant. And I also remind them we have far less turnover than the restaurant down the street.
Why am I being penalized?
We tell parents this is not punishment. All we’re asking for is a guarantee of payment. I often frame a hypothetical question and ask “…when a hotel asks you for a credit card to put on the reservation for incidentals, is that considered punishment? Us trying to collect 4-months after we’ve provided services, that IS punishment (I don’t mention this out loud, but I do say it my head) . All we’re doing is asking for a security. It is not a penalization, it is a guarantee, we emphasize.
You should only apply the policy to people that have a history of delinquency.
We address this issue by letting parents know that it is impossible to know who is going to be delinquent and who is not. Just because a family has a good track record doesn’t mean they will continue having a good track record. They can lose their job, declare bankruptcy or encounter other financial hardships. Therefore, we must be proactive and request that all families give us a credit card. If we wait to find out when patients are delinquent, it is too late.
I’ve never had to do this before at any other doctor’s office.
We acknowledge that this is a departure from what is normally done in medical facilities, but it is not uncommon in other industries. For example, hotels, car rental companies and even Blockbuster all have policies that require one to leave a card on file. Try to stay at a hotel or rent a car without a credit card. If you don’t follow the merchant’s policy, they’ll charge the card, as simple as that. We tell parents that just like Hyatt and Blockbuster, we too want to be paid for our services.
Why I’m being singled out? I always pay all my bills.
We assure parents this policy isn’t personal, thus we apply it to our entire patient panel. We let parents know that we don’t want to be in a position to say who needs the policy and who doesn’t. Hence we have a policy that applies equally to every patient. So instead of having to discriminate, we prefer to apply the policy across the board. By doing it this way, the temptation to play favoritism is eliminated and it removes us from the uncomfortable situation of having to decide who has to follow the policy and who does not.
We always try to reinforce the policy and try to get them to understand that if they are current with the practice, they don’t ever have to worry about having their card processed. The card is only intended for accounts that are delinquent.
Why do I have to “pay” for other people’s mistakes?
I agree with them that a few bad apples ruin everything for the rest of us. In our society, we all have to pay for other people’s bad behavior.
At the airport for example, why do I have to take off my shoes, belt, jacket, remove my watch, wallet, etc., etc., and then be subject to an uncomfortable pat down if I’m not a terrorist? Worse yet, why do my kids have to be subject to the same screenings?
We acknowledge that it shouldn’t have to be this way, but the truth is a few people always ruin it for everybody. And the reason we have to do this is because not everybody pays their bills.
We also remind patients that if they pay their balances within the allotted time frame or give us a call to make payment arrangement, we won’t have the need to process the card. So in essence, they do not have to “pay” for anybody’s mistakes.
I don’t have a credit card.
We remain firm with parents that give us this excuse. The policy is very clear and we do not deviate from it. I tell parents that we informed them about the policy over 6 months before actually implementing it. We gave all families plenty of time to find another pediatrician if they couldn’t comply with the policy.
However, if they still would like to keep us as their pediatrician, then they can pay “cash” for the services we provide and submit their claims to insurance themselves.
Personally, I don’t buy this excuse at all. I know there are people out there that don’t have credit cards, but most have at least a debit card.
I figure they are a few reasons why someone would not have a credit card. Maybe they don’t have a card because they’ve declared bankruptcy, are maxed out, or declared unworthy of credit. If this is the case, then I certainly don’t want to be extending credit to this type of patient.
They might not have a card because they don’t believe in credit or have a moral principle against credit. If this is the case, then they should be accustomed to paying cash for everything. To this patient we offer them the chance to be processed as a “self pay” and they can submit their claim themselves.
In a few more months I’ll be posting how our account receivables have improved as a result of our new policy.