PROBLEM: The Habitual Canceller

SOLUTION: We all have our share of patients who either cancel last minute and worse, not show up for their scheduled appointments. You can confirm the day before and sometimes the same day, yet they STILL manage to break their appointment. Charging them for these missed appointments is usually futile and often harmful to the practice. Collecting the fee is at best difficult and could give the patient cause to “bad mouth” the office. From the patient’s perspective, it’s normal or expected to miss appointments—“how dare they charge me for not doing any treatment?”

Since getting the missed appointment fee is unrealistic, the patient can be handled the following way for future appointments: “Ms. Patient, it is obvious that you have a very busy schedule and it is difficult for you to predict if you will be available for your appointments. To make it easier on you and so that you don’t feel bad, how about you call our office when you have time available and if we have an opening that day, we will get you right in”. This technique no longer wastes time in your schedule and you managed not to offend the patient.

PROBLEM: “ I Forgot My Checkbook”

SOLUTION: You can diligently prepare and inform a patient concerning their financial responsibilities for the next appointment and at times find that they are unprepared or unwilling to make the arranged payment. Some are legitimate in having forgotten to bring a check book and others are professional DEADBEATS. Accepting credit cards, cash and all forms of payment can increase the chances of collecting that day. So, if a patient says “I forgot my checkbook” come back with “we also accept credit card, debit card, or cash”. If the patient has none of these available (falling in the category of professional deadbeat), take out a pre-addressed envelope, write the amount owed in the inside flap, put a stamp on it in front of the patient and hand it to them asking “would you please put a check in the envelope and put in the mail TODAY?”

PROBLEM: “...Nothing bothers me, why do I need X-rays?”

SOLUTION: The standard of care dictates that we periodically take x-rays to rule out pathology. To some patients, this is only necessary if they present with symptoms. There are legitimate concerns on their part—financial, radiation or discomfort (you know of the ones that can’t tolerate film placement). At this point it is necessary to educate the patient. “Mr. patient, though you have no obvious symptoms/problems, the reason we need periodic x-rays is that we may have coincidental findings of pathology such as cavities, dead nerves, gum disease, etc. If these conditions exist, it is best to treat these issues before they become bigger problems or emergencies.”

PROBLEM: “My insurance won't cover this procedure.”

SOLUTION: Insurance is a mixed blessing. It has made treatment more affordable, therefore feasible for many patients. Yet, it can also cause unnecessary distress between the patient and the treating doctor. Because of policy provisions negotiated by employers, there are certain procedures that are not covered by an insurance policy to control premium cost. Unfortunately, when an EOB is returned with the message that “this procedure is not covered under this policy”, a patient can interpret that to mean that you may have done an unnecessary procedure. First and foremost, don’t take offense to the patient’s comment. Explain in a professional manner that the procedure was clinically necessary but because of policy provisions and limitations, “your insurance, provided by your employer, does not cover this procedure. This, more than likely is to control premium costs for your employer.”