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  • Julie DeWolf

When a Patient Argues About a Balance

As mentioned in a previous post, collecting patient balances is essential for the health of an organization, however not the most sought-after job for staff.

Let’s take a look at some of the challenges and ways to approach this task that are a win-win for both the patient and the practice.



Patients often argue for various reasons that the balance on their account are not their responsibility. I like to give some basic ‘scripts’ to my staff to help them navigate these situations. I always recommend a first response to complaints and then further responses may be necessary if the complaint escalates.


A L W A Y S D O U B L E C H E C K


When a patient complains about a balance, the very first thing that I always do, and encourage my staff to do, is to make sure we haven’t made a mistake.


1. Did we process the EOB correctly?

2. Is the patient balance correct according to the EOB?

3. Was it processed out-of-network when it should have been processed In-Network?


If something is incorrect, or we are not sure, my ‘go to’ response is "Let me look into this and get back to you." Always call them back! This will ensure trust on their part that you are concerned about them individually, and usually calms them down and encourages them to pay their portion.If all looks correct, then we can address the patient’s complaint.


R E S P O N D F I R M L Y W I T H E M P A T H Y


Below are a few complaints I have heard before and how I recommend responding.


1. “The doctor was rude and unprofessional, so I don’t think I should have to pay.”

Response: “We are sorry you feel this way, however, requested services were rendered, and per your insurance company, this is your responsibility.” Be sympathetic, but firm – many times this is just a personality conflict.


2. "The doctor was only with me for five minutes!"

Response: “Of course, we were not present at the time of your service, however the provider has indicated that your visit required the level of service that was billed, and your insurance company agreed, therefore the balance is your responsibility."


3. “The service/procedure didn’t work.”

Response: “Unfortunately, seeing a provider or having a procedure is not a guarantee of success, relief, satisfaction, etc." You can sometimes offer up some levity by saying something like ‘Wouldn’t that be great if life was like that!' But end with “This balance is still your responsibility.”

You can sometimes offer up some levity by saying something like ‘Wouldn’t that be great if life was like that!' But end with “This balance is still your responsibility.”

4. “No one told me you were Out-of-Network!”

We can empathize with this complaint because there are so many different and obscure plans now. It is hard for each practice to keep up the provider’s contracting status for each plan within a particular carrier. Depending on the office and what you know about them, there are a couple of scenarios you could go with:


First Response: “Let me look into this and get back to you.” – it may just be an instance of the insurance processing the claim incorrectly, or you may want to contact the office and ask them if they informed the patient that they were out of network. Regardless, it is the patient's responsibility to go to an in-network provider, and we should ultimately put it back on the patient to research.


Second Response: When you know the office informs every patient - “It is my understanding that you were informed of the provider’s non-participation status with your plan, as there are so many different plans, we encourage patients to contact their insurance to determine if their provider is in-network. If you have further questions, please contact your insurance for clarification.”


5. My personal favorite… "The doctor said I didn’t have to pay anything" (Getting into waiving fees and copayments is for another post!)

First Response: Try to get more information as to what was really said, when it was said, who said it, etc. Most of the time, the patient hears things differently than what was actually said, however know that there are some providers who do say this to patients. Once you have as many facts as possible, contact the office with the patient response and find out what the office wants you to do.


Second Response - when a patient is still arguing, refusing to pay or threatening legal action:

“You are welcome to write a letter to the provider indicating your dissatisfaction, however valid services were rendered, and per your insurance this is your responsibility to pay.”


Third Response: If the patient says, "Don’t ever call me again."

We are required by the Fair Debt Collection Act to honor a patient’s request to not contact them if requested. Respond by saying “We will certainly honor your request and note your account, however we are obligated to inform you that this does not excuse your debt, and you are still responsible for the balance on this account”.


Often when I have said something of this sort many people hear: “You are sending me to collections and will ruin my credit!” Just keep calm and remember, this is not personal.

Just keep calm and remember, this is not personal.

The patient is obviously upset, repeat the second response in some manner and remain calm. If you feel the conversation is no longer productive start to move towards ending the conversation.


E N D I N G T H E C O N V E R S A T I O N


Ultimately, you do not have to put up with rude or obnoxious people and are within your rights to cut the conversation short.

Ultimately, you do not have to put up with rude or obnoxious people and are within your rights to cut the conversation short.

First Response: “I understand you are upset, and I think we should continue this conversation at another time when you are calmer.”


Second Response: “Sir/Ma’am, I will not be spoken to in this manner, and am going to hang up now. I will be happy to speak with you when you are calmer.” Then… hang up. They will probably continue to argue or yell.


Remember, this is not personal! Don’t take on the emotion of another person. Just do the best you can, making sure your facts are straight, and be professional.

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