Tell a friend about Pedsource!

Courtesy Discounts

The subject of professional courtesy, ethics, legalities, etc as been
discussed periodically in the past. It seems from what others on the list
have written that the practice of *never* charging a physician's or other
health professional's family is fairly uncommon now unless there is a close
or special relationship. For those who do give professional courtesy in
select circumstances, what do others on the list do when a parent expects a
discount because they work in a physician's office?

Here's a situation I'm facing: there's an OB-GYN whose office is
downstairs from mine and he (and his office staff) have referred a fair
number of patients to me over the years. One of the women who works in his
office as a medical assistant has an older child who's come to me for
several years. She had a new baby about one year ago (divorced and
remarried, so a different father). The co-pays for the older child were
always paid in the past (presumably by the ex-husband). There were
insurance problems with the newborn and finally all the claims have been
processed (though it took one year!). Between two insurance policies,
about 50% of the billed charges for the new baby were paid and about 20%
were written-off as PPO discounts, leaving about 30% owed by the
family. The mom was sent a bill and the next time she brought the child in
for an office visit basically implied that she expected complete
professional courtesy (and also implied that she'd been told by my office
she would get it). My office manager wasn't there that day so called her
(at the office she works in) the next day. I guess the mom must have
discussed it with the rest of the staff in her office, because though she
wasn't there when my office manager called, their office manager came to
the phone and basically said she was surprised that we would balance bill
the mom and that the OB-GYN himself would be calling me personally to
"discuss it."

So, assuming I get the call to "discuss it", what's the best
response? She's already been given the 20% courtesy I'd planned to give if
there hadn't been a PPO discount, and in the past I've only given complete
write-offs to close friends and physicians who I have a close personal or
professional relationship with. I suppose it's not worth alienating this
office, but I prefer to give courtesy at my discretion and not feel
pressured into it.

Anyone have any thoughts?

Michael Sachs, M.D.
General Pediatrician

RE: Courtesy Discounts

Message from Michael L. Webster hidden@email-address

Apologies in advance for the opinion below.

As an employed pediatrician, giving professional courtesy discounts is not
an option for me, although I did at one time.

Professional courtesy is essentially a gift from a provider to a patient.
Where I come from, a gift is a kindness given by choice and accepted with
humility and appreciation. A "gift" given under duress in order to avert a
negative consequence is more like extortion.

Incidentally, I don't think I would discuss the matter with the OB doctor or
his staff members, but only with the mother of your patient. Those others
really don't have any business becoming involved in the matter.

Michael L. Webster, MD
Erie, PA

-----Original Message-----
From: hidden@email-address [mailto:hidden@email-address]On Behalf Of
Michael Sachs
Sent: Saturday, March 23, 2002 4:30 PM
To: hidden@email-address
Subject: Courtesy Discounts

Courtesy Discounts

Michael Sachs wrote:

> there hadn't been a PPO discount, and in the past I've only given complete
> write-offs to close friends and physicians who I have a close personal or
> professional relationship with. I suppose it's not worth alienating this
> office, but I prefer to give courtesy at my discretion and not feel
> pressured into it.
>
> Anyone have any thoughts?

I agree 100% with you and the reply you've already had about courtesy.

However-----given the situation, I think you'll be better off by far financially
to figure this as a loss-leader, tell the mom it was a "misunderstanding" and
give her the "courtesy."

--
Gary M. on LI

Volunteer Your PC for Cancer Research @
http://members.ud.com/services/teams/team.htm?id=6065F531-AD68-47F5-938D...

Courtesy Discounts

I agree with Gary. I would not put it in the newspaper, and would tell the mother
something about you were sorry for the misunderstanding, but you were happy to
accommodate her... Pediatricians don't see many patients if the OB's are mad at
you.
-gb
----- Original Message -----
From: "Gary Mirkin"
To:
Sent: Saturday, March 23, 2002 8:32 PM
Subject: Re: Courtesy Discounts

Michael Sachs wrote:

> there hadn't been a PPO discount, and in the past I've only given complete
> write-offs to close friends and physicians who I have a close personal or
> professional relationship with. I suppose it's not worth alienating this
> office, but I prefer to give courtesy at my discretion and not feel
> pressured into it.
>
> Anyone have any thoughts?

I agree 100% with you and the reply you've already had about courtesy.

However-----given the situation, I think you'll be better off by far financially
to figure this as a loss-leader, tell the mom it was a "misunderstanding" and
give her the "courtesy."

--
Gary M. on LI

Volunteer Your PC for Cancer Research @
http://members.ud.com/services/teams/team.htm?id=6065F531-AD68-47F5-938D...
284

Courtesy Discounts

In a message dated 3/23/2002 7:34:51 PM Central Standard Time,
hidden@email-address writes:

> I think you'll be better off by far financially
> to figure this as a loss-leader, tell the mom it was a "misunderstanding"
> and
> give her the "courtesy."

I don't disagree with reconsidering giving professional courtesy as a
"loss-leader" if you wish, but I would not tell the mom that it was a
misunderstanding. That makes you and your staff look bad when they did
nothing wrong. What's wrong with letting the mother know that you are
treating her special?

Ken Setter
Tulsa, OK
Visit my photo site at: www.pbase.com/ksetter

Courtesy Discounts

Michael Sachs wrote:
> ...their office manager came to
> the phone and basically said she was surprised that we would balance bill
> the mom and that the OB-GYN himself would be calling me personally to
> "discuss it."

In addition to the other comments I've seen, I might encourage
you to ask this OB whether he plans to give free deliveries to
anyone who happens to work for you. Besides referring patients
to you - which is important, but perhaps not worth your dignity
and possible contractual problems - have they ever offerred any
quid pro quo?

In our experience, pediatric offices do *not* get anything
resembling an equal return on professional courtesy.

--
Chip Hart * chip @ pcc.com
Physician's Computer Company * http://www.pcc.com/~chip
1 Main Street * Work:800-722-7708
Winooski, VT 05404 * Fax: 802-846-8178

Courtesy Discounts

Chip Hart wrote:

> In our experience, pediatric offices do *not* get anything
> resembling an equal return on professional courtesy.

That's so true!

--
Gary M. on LI

Volunteer Your PC for Cancer Research @
http://members.ud.com/services/teams/team.htm?id=6065F531-AD68-47F5-938D...

Discounts

HELLO OUT THERE--

Newport Pediatrics offers a time of service (TOS) discount if the patient pays
for their service today resulting in a $0 balance on their account. I have a
couple of questions regarding time of service (TOS) discounts:

1. Do other practices give TOS discounts, and if so, on what services?

2. Do you use a percentage, or a flat amount?

3. Do you find that it makes a difference in encouraging payment at TOS?

4. We normally ask for payment at TOS for all services except those covered by
Blue Cross of Vermont or Medicaid. We have begun to bill a couple of
commercial 3rd party administrators but are still asking our patients to pay
at TOS since we have no agreement with these new carriers. We notice that
the EOB's are coming back paying our office visit fee in full, and yet the
patient has not paid the full amount because of the time of service
discount. We're wondering how to deal with this. Has anyone else had this problem?

We have reluctantly been considering raising some of our fees, but also in-
creasing our TOS discount. In this way, those who must pay out of pocket still
get a break (which was one of our motivations for the discount in the first
place).

We would be interested in hearing any comments, suggestions, or experiences
you've had on this subject.

Thanks for your help.

Mary Fleck, Practice Manager
NEWPORT PEDIATRICS and ADOLESCENT MEDICINE
Newport, Vermont 05855
(802) 334-5929