My billing company needs my approval to send a patient to collections, so once a month I get a list of people who owe me money. I hate this.
I didn’t become a doctor to get rich (actually, being a doctor is probably why I’m not rich). I did it to help people. The list is one of those reality doses I have to swallow.
I generally send them all to collections and try not to think about it too much. I don’t like it, but I have to focus on the basic facts: My practice supports three families (mine and two staffers), and I need to pay the bills.
I scan the list. Sometimes I recognize the names, often I don’t. Many are people I only saw briefly in the hospital. If I know someone legitimately has serious problems and can’t pay it, I’ll often write the account off, but, in general, I send most of the list to collections. Sometimes it’s hard to draw a line.
I often wonder about those I recognize as being people who are employed, nice, financially stable, and (seemingly) honest. I know they can afford it, so why don’t they pay? Believe me, I don’t enjoy approving this. I wonder if they think I won’t do it, or they just don’t understand their insurance, or just believe they shouldn’t have to. I remind myself that shoplifting is still stealing, no matter what the circumstances are, and sign off on them, too.
The amounts vary, from small ($7.43) to large ($485.92 this month). I think about writing off the small ones, but where do you draw the line? If $7 is too small, then why not $10? If $15 is too small, why not $20? So I remind myself that it all adds up over time, think of my kids needing new school clothes, and sign off.
I do this job to help people, but if I can’t keep my practice open I can’t help anybody. And that’s a necessary evil of modern medicine.
Dr. Block has a solo neurology private practice in Scottsdale, Ariz. E-mail him at clinicalneurologynews@elsevier.com.