Free care now could mean big savings later

Patient A has lost his job and benefits, including his health insurance. He's complaining of stress-related headaches and GI problems that so far have not been treatable. You have suggested therapy, but the patient says he can't afford it. Now he's complaining about his care.

Patient B, meanwhile, has undergone Botox treatments, removal of a skin growth for cosmetic reasons, and other services not covered by insurance. Now this patient is dissatisfied with the results. You suspect that he simply doesn't want to pay his bill. Moreover, you're afraid that he is going to file a claim unless you waive your fee.

In these difficult economic times, you may find that more patients are refusing to pay for services rendered and others are complaining more about their care. If you have a patient who matches one of the examples above, it is critical that you maintain communication with him.

Perhaps you could suggest an additional treatment that might remedy the problem, and you might consider offering that treatment for no charge.

Defusing patient complaints by writing off all or part of a bill can be a good legal strategy under certain circumstances. If the bill is small and there are liability issues in the chart, a write-off may be the best decision you can make: Losing a little money now could end up saving you a lot in the future.

That's not to say waiving a bill is the best course of action in all situations. If the bill is substantial, but you're convinced that your care cannot be legitimately questioned, billing the patient may be worth the risk of a lawsuit. In either case, make the decision yourself and never allow the bill to automatically go to a collection agency.

Some practices follow a procedure in which the office manager will occasionally reduce a bill or waive the copay or deductible if a patient has a legitimate complaint or is otherwise unhappy. If you waive a bill with insurance, make sure you are consistent with the rules of that third-party payer. If there is any question about whether there was a deviation from the standard of care, review the chart.

If you decide to waive a bill, make sure that you and your staff stress that you want all your patients to be happy with their care. Never intimate that there could be anything less than the appropriate standard of care.

Of course, waiving a bill doesn't automatically immunize you from potential litigation. While a written-off bill can be introduced into court as evidence, it can cut both ways: Your lawyer will use it to portray you to the jury as a gracious physician who didn't want to burden a dissatisfied patient. The plaintiff's lawyer will use it to depict you as a guilty doctor trying to buy your way out of trouble.

There is a chance, however, that you can head off potential liability if the patient feels like you're working together as a team to solve the problem. Waiving the bill might be a good place to start.

The author is a healthcare attorney in Mt. Kisco, New York, and a Medical Economics Consultant. She can be reached at lj@bestweb.net
. Malpractice Consult deals with questions on common professional liability issues. Unfortunately, we cannot offer specific legal advice. If you have a general question or a topic you'd like to see covered here, please send it to memalp@advanstar.com
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