It’s Not About The Billing Error

I recently accompanied my mother to a doctor’s appointment. We spent an hour in the waiting room and witnessed something that is all too common in patient care and impacts everything from satisfaction to the reputation of the practice itself.

I desperately wanted to rescue the billing representative during her interaction with a patient. If I could have slipped her a script using the ORPO template we teach in our Compassion Mindset course, it would have said,

“I can imagine this is such a surprise. It must be such a shock to expect you were good to go and find out you owe $500. I want to get to the bottom of this and see what we can learn together. Will you come back to my office and we can investigate? I promise to work with you until we have this figured out because we never want our patients to be surprised by a bill. How does that sound?”

An elderly man, probably 80 years old, came in with questions about his bill. From what my mother and I overheard, we gathered that he’d received a notice from his insurance company that a portion of his bill was not covered. He seemed confused and concerned.

The billing person was an expert, very clear on the facts and eager to help. Unfortunately she missed what was really going on. She dived straight into explaining why this man was being charged. Not surprisingly, he became defensive, explaining to her why he shouldn’t have to pay since every other time this practice had accepted the insurance write-off.

It went downhill from there. For nearly 20 minutes the two of them went back and forth, each one getting more frustrated, desperate, and loud. Eventually a manager appeared and everyone in the lobby got to experience the final exchange, “Sir, you’re going to have to call your insurance company. This is not our issue. I’m going to have to ask you to leave!” The patient’s response, “You are obviously not the kind of people I thought you were!”

My mother enjoyed my play-by-play commentary of the whole situation. I explained to her how this patient just wanted to be heard. He was confused and worried and needed someone to empathize and get alongside him to figure it out rather than starting a power struggle. He needed a partner and advocate, not a billing expert. He needed someone to care about him first, and worry later about getting paid.

Compassion won’t change the facts and it can’t make a medical bill disappear. But it will create an environment where we struggle with people instead of against them. It will send the message that we care even while we are trying to figure out a solution. It will guide us in balancing boundaries with concern an empathy.

The alternative is an angry patient who’s looking for another doctor, a medical practice wasting a ton of energy in another adversarial relationship, and a waiting room full of patients who witnessed a lose-lose interaction.

I choose ORPO.

P.S. This patient showed all the signs of a Persister personality phase, in distress. No amount of facts or explaining helps. These patients don’t care how much you know until they know if they can trust you. Loyal Persisters are your biggest advocates. Angry Persisters can become your PR nightmare. Personality type matters in patient care.

Copyright Next Element Consulting, LLC 2019