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Saturday
Oct152011

Patients Billing Their Doctors For Being Late

Guest post by Pam Wible MD

Should patients be holding medical spas or plastic surgeons to the same standards as other businesses?

Meet Elaine.

We lost touch for a while, but caught up with each other recently.

Like most girlfriends, we shared adventures of love, travel, and work. I told Elaine that I left assembly-line medicine. Now I host town hall meetings-inspiring citizens nationwide to design ideal clinics and hospitals.

Elaine shared: ”If I’m kept waiting, I bill the doctor. At the twenty minute mark, I politely tell the receptionist that the doctor has missed my appointment and, at the thirty minute mark, I will start billing at $47/hour.”

Wow! I had to hear more.

Elaine scheduled her physical as the first appointment slot of the day. She waited thirty-five minutes in a paper gown before getting dressed, retrieving her copay, and informing the receptionist to expect a bill. The doctor pulled up just as Elaine was leaving.

Prior to her initial visit, Elaine signed the standard agreement outlining no-show and late fees. On follow up, Elaine knocked on the door and discovered her therapist with another client. He apologized for his scheduling error. Elaine sent a bill; check arrived the following week.

Elaine values herself and her time.

When the Comcast guy told her to wait at home between 3:00-6:00 pm, she said, “Expect a $141.00 bill. Is that okay with your boss?” A compromise: The driver agreed to call fifteen minutes ahead of arrival.

I was intrigued. Who pays for waiting?

Cab drivers charge hourly for waiting. Restaurants may provide a discounted meal for the inconvenience. Airlines cover hotel rooms for undue delays. Some physicians apologize. I offer a gift.

Central to medicine is a sacred covenant built on mutual trust, respect, and integrity. What happens when physicians fall into self-interest or self-pity? Or when physicians are so emotionally, physically or financially distraught by their profession?

Patients suffer. And their wait times increase.

So what’s a doc to do?

  1. Remember: Respect is reciprocal. If physicians are on time, patients will be on time. If physicians don’t cancel appointments with little notice, patients won’t either. Doctors should stop charging fees they are unwilling to pay themselves.
  2. Functional clinics attract functional patients. Patients fall to the level of dysfuntion within a clinic. A chaotic, disorganized clinic attracts chaotic, disorganized patients. Take care of yourself; uphold high standards and healthy boundaries.
  3. Don’t wait. Doctors should apologize for delays. And if presented with an invoice for excessive waiting, doctors should gladly pay the fee. Fortunately, most patients don’t bill at the doctor’s hourly rate.

My opinion. Share yours:

About: Dr Pamela Wible is founder of Ideal Clinics and writes at Freelance MD.

Reader Comments (7)

now I have heard everything no wonder every physician I know counts the days until they close their doors.

What do these patients think the doctor is doing, eating shrimp poolside? After 25 years of practice I have rarely met a doctor who ran late for perosnal reasons. Most of the time a patient was more complicated than expected and forget about the husrs spent arguing with payors, insurance companies and administraitors.

If I ever get handed a bill my patient willget handed a chart and a yellow pages listing other qualified doctors.

10.16 | Unregistered Commentergm

I get really annoyed at patients that show up late which in turn pushes my schedule back. I have to deal with the later patients annoyance. I get even more annoyed by people who don't show up at all without calling. Can I bill them (legally) In addition, maybe doctors should bill for all the extras like phone conversations and paperwork like attorneys. One last comment; the world doesn't revolve around you Elaine. Perhaps there was a good reason for the delay.

10.19 | Unregistered Commenterdisgusted

Elaine, if you are not happy with the waiting, then dont come. Period, end of the conversation.

10.19 | Unregistered Commenteriti

I've been to doctors appointments that went smoothly and I've been to some with horrendous wait times. Is it just a matter of overbooking? Who knows. It doesn't matter if I have an appointment and still have to wait sometimes up to an hour and a half to be seen, I will still lose my appointment if I am 15 minutes late. What's up with that? Maybe the sign at the check-in window should read "Payment due when services are rendered - minus $1 per minute that we are late rendering service". If a popular plumbing service can offer an on-time guarantee, I think the medical industry is also smart enough to devise one. Just my opinion.

11.6 | Unregistered Commenterzh

Unfortunately the plumber just has to put a fixture in and connect the pipes.
Medicine dosent work that way, you never can tell how patients will react to meds or how unstable they may become.
Alot of time is wasted when a very ill patient requires admission between the doctor and the hospital staff. Also some patients barge in.
In critical care i sometines could spend hours stabilizing a patient which then throws off my entire day.

11.6 | Unregistered Commentergm

The patient Elaine has the right to present or mail a bill. I would gladly mail her a check. In the envelope I would also include a list of the other docs of my specialty in the area, as well as a dismissal letter, requesting that she find another physician for future problems. I would view the cost of the check (I think you said $47 for 1 hour wait) a small payment to help weed out a patient that I never wanted to see again or have a relationship with after that anyway.

I absolutely agree that Elaine has the right to bill you as a doc. You have the right to pay her and say good bye. Any doc that agrees to see such a patient in the future deserves to have a clinic full of headaches, which they ultimately will have.

The only practice that her attitude and behavior might be OK in is psychiatry, where every hour you can say your hour is up, see you next time, good bye 99% of the time. Even so, if you find out that a patient is suicidal later in the visit, you might not finish on the hour, and the patient would reasonably expect some extra care (Just as Elaine would if she were that patient).

Obviously in medical and surgical clinics similar urgent or emergent issues occur on a daily basis, and have to be treated, in order to provide good care. There is no way around this, so you can see the next patient "on time".

I am NOT a doc but I take the doc's side because..... If I chose to seek the doc out it is because I hear the doc comes with great references from friends or family. He can choose his patients just as we choose our docs. If I need special attention...it is nice to know he took the time to take care of me as quite often a patient goes for a check up only to find there is a LUMP or something I did NOT know about. That is why I go to THIS DOC. If he finds something unexpected he has to take care of it or he gets a MALPRACTICE SUIT. What do you want? How about a clean bill of health from the doc of YOUR CHOICE or go to another doc and wait about 2 months for an appointment (for many docs the next opening is much longer than that). The doc will be glad to get rid of you. If he wants to GET EVEN... he can send you to anlother doc for a second opinion to verify his findings (which may be nothing but will scare the hell out of you and take more time and money). Docs meet at the hospital for lunch very often and TALK ABOUT PATIENTS JUST AS WE TALK ABOUT THEM. .

How about calling the doc before you leave your house and asking if he is running on time or how late he will be. Then you can change your schedule to meet his. Why get angry... it will not solve anything. My primary care doc is the ONLY one in town that still makes HOUSE CALLS. Does yours?

12.3 | Unregistered Commenterlefty2g

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