When patients will not or cannot pay for treatment, psychiatrists should be
aware that there are liability risks associated with the decision to pursue an
outstanding balance.
One risk is that a patient will retaliate by filing a lawsuit claiming that
his or her psychiatrist engaged in some type of unprofessional conduct,
according to risk management experts with Professional Risk Management
Services Inc. (PRMS), which manages the APA-endorsed liability insurance
program, known as the Psychiatrists' Professional Liability Insurance
Program.
"The most common type of lawsuit to result from pursuing a collection
is a counter-claim from the patient alleging that the services were not
provided at all or that the patient was so dissatisfied with the level of
service that no fee should be charged or collected," said Denny
Rodriguez, J.D., a litigation specialist with PRMS.
It is far more common for a patient to retaliate by filing a complaint with
the psychiatrist's state licensure board or professional membership
organization, which is better known as an administrative action, according to
Rodriguez.
Complaints are also sometimes lodged with health care organizations and
managed care companies with which the physician is affiliated, Rodriguez
pointed out.
In an administrative action, patients may allege that the physician
conducted himself or herself unprofessionally and should be sanctioned for
that behavior, said Marynell Hinton, M.A., a senior risk manager with
PRMS.
Hinton noted that administrative actions are relatively easy for patients
to initiate. Since many professional membership organizations, for instance,
have a greater goal of serving patients, they "are likely to have
complaint forms readily available for patients to fill out and procedures in
place for reviewing a member's standing within the organization," she
said.
She also noted that administrative actions "are not designed to be
fair in a way that lawsuits are designed to be fair" and that physicians
are automatically at a disadvantage in such a proceeding because "the
patient does not have to prove negligence and damages" in an
administrative action as he or she would in a malpractice lawsuit.
Until the patient's allegations underlying an administrative action are
proved false, the costs to the psychiatrist are many and may include money and
time spent fighting the claims, as well as sleepless nights, Hinton
remarked.
She pointed out that health care organizations often have specific rules
and procedures with regard to collection proceedings taken against patients,
and psychiatrists should consult those guidelines before attempting to collect
overdue bills.
For instance, the American Hospital Association in 2003 released a set of
guidelines on collection practices for hospitals. The guidelines address
patients' need for financial counseling and assistance, among other
issues.
Hinton and Rodriguez offered some tips to psychiatrists, which though
seemingly obvious, are not always considered by psychiatrists who decide to
pursue outstanding bills. The information appears in the Fall 2004 "Rx
for Risk" newsletter from PRMS.
Among them are the following:
The American Hospital Association's 2003 guidelines, "Hospital
Billing and Collection Practices," are posted online at<www.hospitalconnect.com/aha/key_issues/bcp/content/guidelinesfinalweb.pdf>.▪