Patients can be discharged from practice for not paying forservices. You are the manager in the front office of a physician’spractice. The practice does not currently offer credit (acceptmonthly payments) to patients. You know that a few of yourcoworkers have recently bent the rules to allow a patient to notpay their insurance co-payment, have not charged for some of theservices provided, or have allowed a patient to make payments ontheir accounts.

Scenario One: An 86-year widow comes in monthly to have herblood drawn and monitored ever since her heart attack 2 years ago.Her husband has recently passed away and she has no family nearbyto help her. She has Medicare but does not have supplementalinsurance to cover office visits. When leaving the office today,she starts to cry and tell you that she can no longer afford herblood pressure medications, cholesterol medications, blood work,and office visits each month. She will not be able to get hermedications refilled unless she sees the doctor and has blood workeach month. She currently owes $180 on her account today.

Scenario 2: A 19-year-old mother of 3 children, all under theage of 5, brings in all of the kids today for their recommendedcheck-ups and vaccinations. She does not have insurance for any ofthe children as she was denied Medicaid based on a previous fraud.She has been diligent paying for the children’s healthcare, withassistance from a grandmother, but she recently passed away. Aftertoday’s visits, she tells you that she only has enough money to payfor services for two of the kids, but not the third one. Thismother has been known to cause scenes and be disrespectful to theoffice staff, and you know that if these children are dischargedfrom the office, they will have a hard time being accepted atanother provider due to the mother’s behavior.

1. How would you handle each of these situations?
2. Is one scenario worthy of breaking the official rules? One morethan others?
3. If you must discharge these patients for non-payment, whatadvice will you give them?