Question

Patients can be discharged from a practice for paying for services. You work in the front office of a physician’s practice. The practice does not currently offer credit (accept monthly payments) to patients. You know that a few of your coworkers have recently bent the rules to allow a patient not pay their insurance co-payment, have not charged for some of the services provided, or have allowed a patient to make payments on their accounts.

Respond thoughtfully to both of the scenarios.

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

Scenario 2: A 19 year old mother of 3 children, all under the age of 5, brings in all of the kids today for their recommended check-ups and vaccinations. She does not have insurance for any of the children as she was denied Medicaid on the basis of a previous fraud. She has been diligent paying for the children’s healthcare, with assistance from a grandmother, but she recently passed away. At the conclusion of today’s visits, she tells you that she only has enough money to pay for services for two of the kids, but not the third one. This mother has been known to cause scenes and be disrespectful to the office staff, and you know that if these children are discharged from the office, they will have a hard time being accepted at another provider due to the mother’s behavior.

1. How would you handle each of these situations?
2. Is one scenario worthy of breaking the office rules? One more than other?
3. If you must discharge these patients for non payment, what advice will you give them?

Answer 1

1. Situation 1 Staff should ensure that the old lady sits comfortably in a chair and in a safe environment. The old lady must be explained the situation in a polite manner by the staff using simple and plain language. Any kind of sophisticated and medical terms should be avoided and instead staff should use simple and comprehensible language. Staff must tender an apology for the inconvenience caused to her by this situation and staff using polite language should empathize with the lady.

Situation 2.

The young mother should also be counseled and and explained the policies of organization and how her past behavior had a negative impact on her life in a calming voice and not in a blaming or judgemental tone. Staff should ensure his/her safety as well as young mother's safety.

2. In both cases there is no point in bending or breaking rules or organizational policies. And, nurse shouldn't suffer any kind of ethical dilemmas here as past unethical and unprofessional practice of the colligues is not a standard practice. But, in both cases nurse should empathize with the clients and must break the bad news in a polite inoffensive way.Finally both scenarios are clearly not worthy of breaking rules. Breaking rules or routines may be ethical in some rare EMERGENCY situations ,here in both cases no emergency life threatening situation is involved.

3.They shouldn't quit their efforts as treatment is important. They are encouraged to look for alternatives and also to approach the higher authorities asking for an exception or relaxation in rules .