Patient Media


Presenting Your Patient Financial Policy

by William D. Esteb

Money. Fees. Collections. This topic brings so many chiropractors to their knees. No other subject so effectively touches on one’s self-esteem, self-worth, risk tolerance, confrontational abilities and communication skills. How you determine patient fees, achieve patient acceptance, deal with third parties and handle collections becomes a barometer of countless other aspects of your practice. Income, referrals, patient satisfaction, profitability, compliance—even your marital relations are affected by this one dynamic. You’ve heard the approach of consultants, management experts and other chiropractors. Here’s a different perspective: a patient’s point of view.

Shooting the Messenger

Poor collections and uncollected balances are a symptom. As with health complaints, treating symptoms rarely produces lasting benefit. Treating the symptom with letters, collection services, attorneys and small claims court is often counterproductive. You may win the battle but lose the war. The cause is often a lack of a clearly explained financial policy or its poor administration.

The fact is, if you’re involved with a lot of third parties, you’ll need to manage the patient’s health complaint and their pocketbook. Many patients don’t discover the limitations of their policies until they show up in your office. You may find yourself educating patients about how the “business” of health care works these days. Identify the shortcomings of their coverage before they even begin care. If you don’t, patients are likely to “shoot the messenger”—you—rather than blame their profit-motivated carrier. Offices with excellent collections find that they must offer patient education and financial education.

Put It in Writing

Practices with high collections (in the 90% range and higher) enjoy high levels of patient satisfaction, which translates into more referrals and a more stable practice. Clarifying your financial policy is essential.

Many offices with collection problems try to remain flexible, ready for anything and everything. It’s often a sign of opportunity-chasing and a lack of focus. Trying to be all things to all patients is a recipe for frustration. Part of having the practice of your dreams is to have a dream! What do you want? Your financial policy helps determine who belongs in your practice. Without a written policy (properly administered) you become a target for irresponsible patients and become tempted by the “let’s make a deal” mentality that bites back weeks or months later after the patient is feeling better and owes you hundreds of dollars.

Using a Patient-Understandable Structure

Most of the financial policies I’ve seen over the years are structured in a way that makes sense for the doctor. They either list their fees based on the services that are offered (exams, adjustments, X-rays, etc.), which are often meaningless to new patients, or try to make the case for wellness care at a time when a patient isn’t even sure chiropractic will work for their presenting complaint!

Patients don’t know the purpose of adjustments, therapy or an orthopedic examination. Since most patients bring their medical doctor experiences with them, they need some orientation.

Since chiropractic care is delivered over a series of office visits, why not arrange your policy so that it reflects how patients actually encounter your office? What procedures (and why) will be performed on the first visit and what are the fees associated with them? What happens on the second visit and how much does it cost? What happens on a regular visit? Why does chiropractic care take multiple visits? And how much do they cost? Same with progress examination visits. Use your financial policy to map out your office procedures and explain their purpose and benefits.

Third-Party Motives

Part of your financial policy orientation should be a review of the motives of all the parties. Clarify the motives of your patient for having consulted your office. Clarify your motives for accepting them as a patient. Explain the motives of their HMO or insurance company. (It’s not your patient’s health!) What you’ll notice, if your practice is truly about “health” care, is that you’re stuck trying to serve two masters—the patient and their HMO. Predictably when it comes to serving two masters, you love the one and hate the other. Chances are you hate their stingy, profit-motivated HMO.

But consider the same scenerio from the patient’s point of view. Should they serve or follow the recommendations of their “financial master” or should they take the recommendations of their wellness-oriented “health care master”? Who is likely to have the greater influence over your patient?

You’re Not a Bank!

Many times the financial aspect of the doctor/patient relationship gets out of hand because patients run up their outstanding balances over weeks and months of care without being asked for payment. While this problem can be partly administrative and procedural, the real culprit is often a lack of a clearly set “credit limit.”

Like the expiration date printed on many packaged foods, outstanding patient balances are perishable. The larger they get and the longer they remain uncollected, the less the chance of actually seeing the money.

Set a credit limit and put it in writing in your financial policy. That’s the easy part. More difficult for some is to have the discipline to enforce the limit, denying care when the limit is reached without the patient taking steps to take care of their debt.


But they won’t like me! They might drop out of care! They won’t follow through on my recommendations! They won’t get the optimum results chiropractic can deliver! I’ll be accused of patient abandonment!

Without the discipline (and courage!) to make the patient responsible and accountable for their health, several even more disturbing things happen. First, their respect for you diminishes. (If you don’t respect yourself enough to demand payment for your services, you must not be worth it.) Secondly, they refer their similarly irresponsible friends to your office. (Birds of a feather flock together.) And thirdly, you’re tempted to send nasty letters, turn them over to collection or take them to small claims court. Actions that sully the relationship considerably more than asking a fair price for your services and expecting payment. (As for abandonment, if at the beginning of the relationship they agree to pay you and don’t, it sounds like they’re abandoning you!)

Individual Consideration Contract

Poll a group of staff members out of earshot of their doctors, and a common frustration is the “deals” their doctors make with patients. While the staff is somehow expected to administer these special payment cases, the arrangements are rarely written down. Whether this is because of the shame doctors feel for compromising their published fee structure or simply a desire not to leave a paper trail for some insurance company auditor to discover is unclear.

You have every right to make special arrangements with patients for whom financial hardship exists. It’s the right thing to do. Just put it in writing!

Presenting Your Written Policy

In the old days when everyone had insurance with $100 deductibles, it made sense to delegate the financial presentation of care to a staff member to cover with your patients. Times have changed.

Give patients a copy of your financial policy to review after they’ve completed your admitting paperwork. Then, during your consultation, walk through the main points of the policy and reach agreement with the patient.

If you think getting your hands “dirty” by discussing money with a patient diminishes your clinical reputation, think again. That’s old-school thinking. Maybe you have the luxury of compartmentalizing and separating your fees from their care, but patients don’t. Do you separate the taste of the lobster from its cost when eating out? Of course not. Neither do patients.

If presenting your fees to patients is a frightening prospect, you may have some money issues of your own to resolve. Are you overcharging? Are you worth it? Would you pay for the care you’re asking patients to pay for? Resolving these and related self-esteem issues could dramatically enhance your practice. It would improve collections. It would improve patient satisfaction, ultimately increasing referrals.

In any relationship, if there isn’t a fair exchange, it is doomed to be a short-term relationship. If patients win and you lose, you become prone to burnout and the emotional detachment that puts a practice into a slow death spiral. If you win and your patients lose, then you put yourself on a constant, stressful search for more new patients to exploit. And it all starts with your perception of mmmmmmmmoney.

Excerpted from
What a Patient Wants
Published in 2002
240 Pages
US $24.95

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