Collections after Covid-19
Risk Management

Balancing the Need to Collect Fees With Patient Goodwill

Although determining how aggressively to collect patient fees can be a difficult decision for DCs in any economic environment, this is especially true in the wake of the coronavirus crisis. Consider the following scenario:


Casey Vallance, DC, was an independent contractor who worked for a doctor who aggressively pursued unpaid collections. This approach soon created problems for Dr. Vallance, even though he had no involvement with the practice’s approach to collections.

Dr. Vallance provided a 10-day course of chiropractic care to a patient who had chronic headaches. Dr. Vallance felt the treatment was making progress, although the patient was noncommittal about whether her pain was abating. Following the patient’s last appointment, she told Dr. Vallance that she did not obtain the pain relief she wanted, and consequently, would refuse to pay for the cost of her chiropractic care.

Dr. Vallance shared this information with the practice owner who decided to attempt to collect the patient’s fees anyway. Before making this decision, the owner reviewed Dr. Vallance’s records and concluded his care was appropriate. For this reason, and due to his tight financial situation, the practice owner decided to stand firm on the fees.

Therefore, the practice aggressively and repeatedly requested payment from the patient. She became infuriated and subsequently filed a complaint with the state's licensing board against Dr. Vallance and the practice owner.

Difficult Situation

Although many doctors feel the pressure to collect all money owed during tight financial times, collections can be a sore spot with many patients. Consequently, the practice should consider the risk/benefit ratio of engaging in aggressive collections practices. It is often easier to forgive a fee than incur the wrath of a patient, which often leads to bad “word-of-mouth” comments about the practice in the community.

From a risk management perspective, agreeing to waive a patient’s fee may prevent a patient from being unhappy—and one who’s less inclined to file a complaint with your state board. Conversely, the decision to aggressively collect can be the trigger that prompts a complaint—even if the clinical care was appropriate. This was the case for Dr. Vallance. His problems were caused less by his own actions and more by the practice owner's aggressive collections stance.

If You Decide Not to Collect

If you decide to waive any fees, make sure to execute a release stating the patient agrees not to pursue a claim against you. A copy of the release should then be placed in the patient’s record along with other documentation on the patient’s care.

Although there are no guarantees that a patient will not pursue litigation after signing a release, taking this step may resolve the matter. Keep in mind that any release should be drafted with the assistance of your practice’s legal counsel. (Contractual, regulatory and legal considerations may apply with waiving fees/copays/deductibles.)

The Best Alternative

Especially now, patient collections is a challenging concept that should be handled on a case-by-case basis. Although all factors should be considered, many doctors conclude that agreeing to waive a patient’s fee is less “costly” than the potential consequences of not doing so.


The information in the NCMIC Learning Center is offered solely for general information and educational purposes. It is not offered as, nor does it represent, legal or professional advice. Neither does this information constitute a guideline, practice parameter or standard of care. You should not act or rely upon this information without seeking the advice of an attorney familiar with the specific legal requirements of the state(s) in which you practice. If there is a discrepancy between the site and an insurance policy you have with NCMIC, the policy will prevail.