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I have always had conditions displayed in reception that payment for treatment is to be paid on day of service, or pick up of orthotics.

I have recently been asked by a couple of patients if they are able to pay in instalments for orthotics?

Is this something that other podiatrists offer?

I have played a bit hard and said No. However I do take credit card so I see this is an option for those who dont have the cash upfront

I just dont want to have to waste time chasing people around for payments and being at a loss for those that fail to come through.

Any comments??

I think it would be bad idea to take payment by installments.

If you set up something like a direct debit system and the patient defaults on their payments how will you chase up the outstanding money? Legally, how water tight could you make any documents you get the patient to sign? and how much would it cost in lawyers fees to get such a document and chase up anyone who needs chasing up? It'd be easier to pass on the debt to a collection agency but then... who wants to deal with those buckets of cess?

I am sure that the majority of patients would probably honour the payments, but there will always be the few that could spoil it and take advantage of the system, or who honestly run out of money and then can't pay.

Don't mean to sound too negative... But IMHO I don't think it is really worth the headache.

Regards,

Sam

I routinely require half the orthosis case fee at the time of evaluation and casting for the custom foot orthoses and then require the other half of the fee when they return in 3-4 weeks for orthosis dispensing. In addition, in hardship cases, I will have the patient pay for half the orthosis fee at the time of evaluation and casting and allow monthly payments after that time. We also have a credit card/debit card machine that allows the patient to "set up their own personal payment plan" if they wish. I think that the clinician needs to be flexible with allowing monthly payments to be made for those patients that truly need their services and are having difficult financial times. However, I don't think this should be a regular office policy for most patients.

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Sincerely,

Kevin

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Kevin A. Kirby, DPM
Adjunct Associate Professor
Department of Applied Biomechanics
California School of Podiatric Medicine at Samuel Merritt College

e-mail: kevinakirby@comcast.net

Private Practice:
107 Scripps Drive, Suite 200
Sacramento, CA 95825 USA
My location

Voice: (916) 925-8111 Fax: (916) 925-8136
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I do know much about this, but I would have thought that letting someone pay in installments is legally extending them credit. If that is the case, then there is a lot of legislation in place regarding credit contracts, etc, that I would assume you would have to be in compliance with.

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Craig Payne
Department of Podiatry
La Trobe University
Melbourne, Australia
http://www.latrobe.edu.au/podiatry
__________________________________________________ ___________________________________
God put me on this earth to accomplish a certain number of things - right now I am so far behind, I will never die.
The views expressed above are those of the author and not that of La Trobe University
This is where I am, where are you?

Hi
Very relivant thread in the current financial climate.
I would agree with craig on the financial basis. The second point is do we look at this from a business view point or do we look from a clinical viewpoint.
If we look at clinical view point to allow patients to pay in installments That could help from a financial basis and increase our appeal to patients who would have thought they couldn't afford our services.
From a business view point that extended credit could be provided by a secondary company who would charge a premium for this. second option is the provider charges a premium for this as the payment is being spread and other companys would charge extra for this service. If we use a secondary company to extend credit terms then we as the clinic aren't responsible if defaults occur and also its the company's responsiblity to adhere to the laws governing this area .

Dave

Maybe the laws are different from one country to the next. However, if you, as a podiatrist, told a patient that they could pay for the second half of a large ticket item, such as custom foot orthoses, 3-4 weeks after the first half was paid, with no interest charge, why would your governmental authoriities worry about you trying to ease the financial burden on your patients?

__________________
Sincerely,

Kevin

**************************************************
Kevin A. Kirby, DPM
Adjunct Associate Professor
Department of Applied Biomechanics
California School of Podiatric Medicine at Samuel Merritt College

e-mail: kevinakirby@comcast.net

Private Practice:
107 Scripps Drive, Suite 200
Sacramento, CA 95825 USA
My location

Voice: (916) 925-8111 Fax: (916) 925-8136
**************************************************

I have a lot of pensioners around my area and they just can't afford orthotic costs up front. I'd rather they get them straight away because they need them and let them pay them off, rather than save up for them. I've allowed installment payments in quite a few cases. I usually get them to pay enough up front that it would cover any lab fees in case they didn't follow through. I've yet to have anyone not pay up though. Most are pretty grateful for having a way to work it out. I think it generates great goodwill. It can't all be about the money. Our job is worth so much more when you know what you do makes a difference rather than just getting paid.

Making a difference is nice. It does not pay the overheads of running a clinic. If I want to do voluntary work then I can do that outside of my biz.

I can not go into any shops, get my car serviced, my hair done, (not that I do that) or go to a restaurant, or my dentist and not PAY.
Why is it people think that the years worth of training we do is not worth getting paid accordingly?
Over many years we have had a couple of clients we know very well pay them off. Those 2 or 3 who have been "hard up" and we tried to help, were a P.I.T.A.
I agree with Kevin, Dr Weed advised down here in Tasmania way back in the 80's, always get a deposit up fronts for at least you out of pocket expenses. The greater the deposit the better the client feels when they come in and only have to pay a small portion towards the end. (no reserach just many years of experience)

Cheers

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Heather J Bassett
137 Wheatsheaf Road
Glenroy 3046
Victoria
Australia

Approach Patient requirements case by case - these are people you are helping, usually in many more ways than just with their foot pain.

Yes business is business, but as we all know, the strict adherence to "All Patients must follow the same protocols..." is not realistic.

I often allow patients in need, to discuss and agree to various terms; as to "extending credit", I suggest we can all set our own terms of payment rather than enter into a formal credit arrangement.

Occassionally I just give a patient in need what they require and absorb the cost. I'm sure MOST people do exactly the same thing, just in various forms.

Bottom line - help patients as you can whilst minimising risk by covering your costs first, but be open to helping in other ways too.

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Paul Dowie

I dont see the problem with paying my installments. This will only be for a very small percentage of your clients.
If they have paid the deposit, keep possesion of the orthotics as security until full payment is made.
I also agree with Paul sometimes its just better to absorb some of the cost

This is an interesting scenario- I have yet to be asked for such, but am always on the lookout for problems encountered by others. There are many things in business that I was not aware of until I was the one doing all the number crunching.

I also ask for payment to cover lab costs, then the remaining half on issue. Its nice to know that others share the burden of cost in a similar way.
There are the odd few who want to pay everything up front, and I love those ones.

Maybe you can offer a reduced rate if patient can pay 'up front'...

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Paul Dowie

I am also practice manager to my spouse's denture clinic (yes- Foot & Mouth!) and I agree with you re credit legislation. The dentists operate this sort of thing at arm's length through a Pay As You Go company who essentially "pre buy" the debt and assume all responsibility for the conclusion of the transaction. It is not worthwhile for them under $1000. You essentially pay a contract fee to them. Likewise if you attempt to collect the debt through Small Claims Tribunal , there is a fee, a lot of stuffing around(= $$s) and bad blood on the grapevine. Debt collection agencies usually take about 20% in commission.Get the quote firmly established - from that point on it is a contract and stagger the payments leading up to the final one on dispensing.

Apart from Cosmetic Surgeons and Dentists - who else offers time payment? Your optometrist or the bloke who does an unexpected expensive service on your car?
Robyn Hood

I always ask for a deposit which covers the lab etc and then the rest of the payment when the orthotics are fitted. I have had a few patients who have left me high and dry but they are the ones who could well afford to pay but just forgot. I have had one lady who needed orthotics but couldnt afford them so she offered to pay off her bill by cleaning my house and surgery up to the value of the orthotics. I had another guy a gardener who landscaped my garden in return for his sons orthotic and verrucae treatment!!! I also offer gift tokens which are very popular, normally bought by a daughter for moms birthday or christmas present and covers from one to any amount of treatments usually 6 in one year. I think its easy to treat each request if you know your patients but a dangerous route if you let the world know you are an easy touch. Hope this helps.

Has anyone ever bought a gift voucher for functional/ custom made orthoses?

MelbPod, I manage a Podiatry clinic ... we have a well documented process which we train our staff on specifically for the Custom Orthotics. From the time a patient calls in for an appointment until they come back to pick up their orthotic devices, they are communicated the same information.

Orthotics are custom made for the patient only and cannot be resold to another individual. Because of this, there is a $100.00 deposit due at the time of casting and the remaining balance is due at the time they are picked up. If insurance is involved, they will get their deposit refunded to them once the entire account is paid in full. We call on insurance benefits prior to casting and the patient is required to sign a financial information form indicating that insurance benefits are not a guarentee of payment and they are ultimately responsible. The patientis also given a copy of this signed form. We do not waiver on this process... anymore. By experience , when we have given exception to the policy we have been burned.

If a patient does not want to pay for their orthotics, we don't do it. We write a prescritpion for them to take elsewhere. The doctor hates when this occures , because obviously he wants the orthotics made a specific way . When sending out to a lab or DME provider there is no guarentee what they are going to get. However, he is good at explaining this to the patient. So the patients willingness to pay for the devices is greater.

Hi Tree Harris, Most gift vouchers are for general treatments eg nail treatments and corns etc but I have had vouchers requested for biomechanical assessments scanning and orthotics either individually or as a whole package for a family member. My practice is mostly general podiatry with some orthotics. The business in Ireland is very different to "down under". We are still unregulated here and most of us register with the HPC in the UK as there is nothing in this country. It is very frustrating. With the credit crunch getting very bad here I am finding people are getting very adventurous with the way they pay their bills. The swap system is starting to take off. Today I removed a corn for a local florist who paid me in flowers and I was asked if i would provide monthly nail trimming for an aged parent in return for a free sailing course. I have always offered a small discount for anyone who works locally to my business and often give a free cream or maybe a massage to someone who sends me a new patient. I have been qualified for almost 20years and one thing I have realised is that it is very difficult to decide who reallly is hard up. Often the most obvious person is the one who least needs it and often the person who asks for discount is the one who will be going on a cruise next month. Hope this helps the discussion!!