O ne of the most overlooked areas of practice management, meaning the management of your practice, is in the area of finances. For whatever reason, doctors of chiropractic have struggled with this area due to lack of knowledge, lack of the ability to confront the situation or lack of effective team members to assist in this important area. The most important concept when asking for payment from a patient is that of perceived value. The patient must assess a value either at or greater than what they are being charged in order to be on board with the cost of the service. It’s equally, if not more important, for the staff member dealing with the finances to understand the perceived value of the service for themselves. As the saying goes, it’s difficult to sell what you don’t own. I have consulted with many offices where the primary staff member whose job it is to collect payment, has confided to me that she just can’t ask these poor people to pay for what she couldn’t afford.
My favorite chide to doctors: “Stay out of the patient’s pocketbook, because you don’t know what they can or can’t afford.” Do not prejudge what a patient can or can’t do financially. How many times have you had a patient who complains the most about money drive up to an appointment in a very expensive car? Or a patient who you never would believe can afford your care write a check for a large sum of money? It all centers on the value that a patient places on the care. I wish I could tell you how many times in my career I have had a patient tell me they couldn’t afford the care recommended to them, then, a week later, I ran into them coming out of the nail salon. This is a patient who did not have perceived value instilled upon them by the doctor. Our job is to tell the patient what they need to hear, and then let them make their own financial decisions.I believe that the “why” is easy to figure out. More important is the “how.” First, let’s look at some ways to maximize your results when asking for payment from a patient or describing their financial responsibility.
- Assume you will get what you ask for! If you assume you can’t, you’ve already lost.
- Be prepared! The Boy Scouts know what they are talking about! Have the doctor’s treatment plan, the insurance verification information, and everything else you will need to formulate an appropriate financial plan with the patient.
- Know when NOT to talk! Don’t try to fill the silence while we wait for the reply from the patient. Be clear about your request, and then wait. For example, say, “Mrs. Jones that will be $45 for today.”
- Have an array of options. If a patient can’t pay for a visit’s charges, be prepared to offer alternatives, such as a pre-addressed envelope they can mail back with the payment as soon as they reach home.
- NO! is not the end of the world: Remember that the most important technique of all is to know you can get what you want by asking and, if it doesn’t happen, be prepared to say, “Next!”
The following are some helpful scripts that you can use in your financial report of findings to help increase your odds of getting to Yes!
Know when NOT to talk! Don’t try to fill the silence while we wait for the reply from the patient.
Objection #1: The patient wants to wait till next visit to decide. Our problem is that we expected to put both the balance of yesterday’s visit and ongoing care into a plan for them.
“It's not a problem, Mrs. Jones, if you need to speak to your husband. I know that I wouldn't want to make a decision like this without my husband present, either. That is why we hoped he would be able to attend this visit, so that he could better understand what's going on with your care. Let's go ahead and take care of your balance to date, so we can start with a clean slate on the next visit. After you've had a chance to visit with Mr. Jones, we will be able to recalculate a payment plan that will work well in your budget. Today's charges added to yesterday's balance will be $150.”
Objection #2: The patient wants to make a further decision about care beyond insurance coverage once insurance visits are used.
“Mr. Smith, I understand what you may be thinking. However, if we were to only recommend the amount of care covered by your insurance, this would be a tremendous disservice to you. Your third-party coverage was never meant to cover all of your care. That's the reason we've joined companies like ChiroHealthUSA, to be able to extend to you a contracted discounted rate for the portion of your care that needs to come out of pocket. I would much rather look at how we can spread this across more time and work with your monthly payment, than have you consider not taking all of Dr. Jones's recommendations. The 15 visits covered by your insurance will only be the acute phase of your care. As Dr. Jones explains, to stop your care at that point would be like taking your braces off after just a couple of months of treatment. Again, that's the reason why we try to make this affordable.”
Objection #3: The patient feels the total amount for care is too far out of their budget.
“Yes, Mary, I understand that this amount may be outside your budget. We have already been able to discount your fees considerably by discussing ChiroHealthUSA, and my concern is that, if we go visit by visit, you will find that it gets out of hand. My experience is, patients tend to get out of pain and then think they can do it on their own. What can I do to help you make this more affordable so that you can commit to the full treatment plan recommended by Dr. Jones?”
In closing, remember that he who asks the question controls the conversation. Not only is it our duty to ask for and collect payments from patients, it is a part of the healing process. That patient who pays will stay and get better quicker. Asking for anything increases the odds of getting it by 200%. Once you master this skill, exercise the asking muscle often, and you’ll be surprised at how effective it is.
Kathy Mills Chang is the President and CEO of KMC University, a consulting and training company in the areas of Medicare, collections, documentation, coding, billing, patient finances, and audit protection. Kathy is also a sought-after speaker, and can be found delivering seminars at the most important events in the chiropractic field around the country. She can be reached at
or through www.kmcuniversity.com.