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Monday, February 6, 2012

Being Charged for Missed Appointments

By Rod Moser, PA, PhD

Medical Bill

It was bound to happen. Times are, indeed, changing. For the longest time, medical practices have been struggling with what to do about patients who miss appointments. The Washington Post recently printed an article about the growing trend of some doctors who charge a (non-refundable) down payment or put a credit card hold for medical appointments. You don’t show up, you forfeit the deposit. Will it work? Will it just anger patients in a competitive market? What about patients who are always late for their appointments? Will insurance companies pay for these missed appointments? Don’t count on it.

There are two sides to this story. For some reason, medical providers and their patients occasionally develop an adversarial attitude about appointments. Some arrogant doctors feel they can take their sweet old time and make patients wait…and wait, often for hours, sitting in a cramped reception area (I was going to say waiting room!).  A doctor that I knew in Southern California made his patients wait up to four hours. He felt that if they wanted to see him, they would wait. He felt that he was worth waiting for, and apparently most of his patients tolerated this attitude. A pediatric urologist in my area had block appointments. In other words, he would have a dozen or more patients come in at the same time. He would then see them one at a time, with the last patient waiting about three to four hours. Some savvy families, aware of his practice, would come prepared for the long wait with videos, books, and food for the kids. Since I hate waiting, I would have exercised my right to get up and walk out after a half-hour or so, unless I was given an explanation.

I feel really bad if I have to make a patient wait, so I always apologize and give them an explanation. If a patient is really ticked, I may even refund their co-pay or not charge them at all. It depends on the circumstances. If a patient still cusses me out or gets in my face for being late because I had a sicker patient in the previous room, we have a conundrum. I may not charge them for the visit and ask that they change medical providers in the future.

Medical providers get sick or have family emergencies and must re-schedule appointments. Medical providers occasionally run behind, mostly because they cannot anticipate the unknown. A patient makes an appointment for one thing, and then tries to maximize their visit by coercing the medical provider to handle about six other, undisclosed health issues. A patient may be in crisis or have a more serious health issue that takes more time. If the medical provider works on 15 minute appointments, that miniscule time allotment will quickly be depleted. They will be running into the next patient’s visit time. Multiply that by ten or twelve patients. The last ones are going to be very inconvenienced. If one patient is late, for whatever reason, you can run behind all day. Patients get angry, and angry patients complain. They may even come in late for the next visit on purpose to punish the medical provider, or worse, not show up at all.

I had one family in my practice that had a zillion kids. She had so many “no shows” that I wanted her discharged from the practice. The straw that broke the camel’s back was the day she no-showed for FOUR back-to-back appointments for her sick children. That is a one-hour hole in my busy day. She then convinced the receptionist to reschedule those four missed appointments in my coveted evening appointments, which I only reserve for very sick kids. She didn’t show up for those either – eight no-shows in one day, a new clinic record. The way I look at it, I could not see eight other sick kids that day because of her lack of consideration. If I could have charged her, I would have, but unfortunately, she was on state-provided insurance (Medicaid) and there no provisions to charge for missed appointments.

I have a personal policy not to turn down late appointments, but I do appreciate an explanation and I ask them to wait until I see a scheduled, on-time patient first. Most of the time, there are legitimate reasons for being late: a flat tire, a speeding ticket, traffic, lack of parking, or even an honest admission that they forgot. I forgive them and get on with my day. Perhaps because my wife is always late when we are going somewhere, I am more tolerant of tardiness.

A completely missed appointment is an entirely different problem. Sometimes, missed appointments are a blessing – a gift of time on a busy day. It gives me to time to catch up, make some phone calls, or even go to the bathroom! There are days when you absolutely have to get out on time, yet your schedule is impacted, and a few patients are late. A few times in my career, I have purposely put my own grandchildren at the end of my busy schedule, knowing they would not show up. I can’t believe I revealed that scheduling secret.

People have phones. They can call and cancel if they are running terribly late. I give patients a few “no-shows” because we are all human and forget, but repeat offenders are going to get a letter from me. Our office does track and monitor no-shows. We can’t charge for missed appointments (yet) but we do send them a letter. As a matter of fact, we have about four or five different letters, depending on how many no-shows they accumulated. Serious offenders can be legally discharged from our practice, but in reality, it rarely comes to this.

Medical provider time is valuable. Patient time is valuable, too. There must be some mutual courtesy here or someone may need to pay a price.

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Photo: Nurgul Kutlu Kurtbas

Posted by: Rod Moser, PA, PhD at 2:21 pm


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