A few months ago my office manager knocked on my door. “Our collections attorney set a court date for the Johnsons. He wants to know if you still want to pursue it.”
“Who the heck are the Johnsons?” I replied.
She told me I treated them back in 2012 and they never paid their bill. After numerous ignored billing statements and voice mails, our attorney was able to get a hold of them but they still refused to pay. The only remaining tactic was to take them to small claims court.
“How much do they owe us?’ I asked as I read through the patient charts.
“About $280,” my office manager shrugged.
I raised an eyebrow. Would it be worth it to close my office for a morning and show up in court for $280? Surely that would a dumb business move. I held my breath for a moment. “Screw it… yes, I’ll be there.”
Court Date #1
I arrived at the small claims court with a neat folder of patient records and copies of insurance claims. After rereading the Johnsons’ charts the day before, I was angry when the details of the case came to light. I did a few composite fillings for Mr. Johnson and my partner did a post and core for Mrs. Johnson. Then they disappeared without paying their copayments. They never returned our calls or answered our letters for months and months. What gives?
The judge announces our case and my attorney steps forward. I hadn’t met him before but he’s done a great job handling the few collections accounts we’ve had over the years. The Johnsons had both showed up and that was pretty darn awkward to see them in the flesh again. We step out of the courtroom with them (they didn’t bring an attorney) to see if we can resolve the matter before being sworn in. I then learned why they didn’t think they should pay the $280 that they were contractually obligated to pay my office. This is fascinating:
Lame Reason #1: “No one explained to us what the $280 was for.”
Really? Hmm… well maybe if you had bothered to return any of our phone calls or respond to our numerous letters, we would have been happy to explain what the bills were for. And my front desk always gives patients a heads up on what their next visits will cost them and how their insurance benefits will work.
Lame Reason #2: “One of the teeth you filled needed a root canal and crown.”
At this point I produced my patient record, which clearly documented the story of the tooth in question. # 3 had gross decay and I had excavated and placed IRM. I had done this procedure a second time (at no charge) as the patient was feeling better but not 100%. The next week I had called him at home to see if he was doing better and he stated he was. On the third and final visit he agreed to have a final composite filling placed. ON ALL THREE VISITS I had documented that “pt informed tooth may require further treatment in the future including but not limited to RCT and a crown.” Booyah.
Lame Reason #3: “I didn’t think my copayment would be so much.”
This one was from his wife. She said that my office manager had told her that she had great insurance and that the post and core (done by my partner) would not be a large out-of-pocket expense. Then she got the bill for $60 (part of the total $280 that was owed) and she was upset. Apparently she thought it wasn’t going to be that much and therefore she didn’t have to pay it, or something. We tell patients ahead of time what their copayments will be but every now and then a patient wants work done before the Estimation of Benefits comes back. That’s fine, but they then lose the right to complain to us about how much they have to pay. We estimate their copayments to the best of our ability in those cases. And here she was complaining that $60 was more than she thought it should be. When I buy groceries and the total comes out to more than I thought it would be, I’m not allowed to pay what I feel like and walk out with the groceries. That would be theft.
Lame Reason #4: “Another filling you did had to be redone by my new dentist.”
At this point Mr. Johnson produced a copy of his radiographs from his new dentist. My attorney stepped in and said those aren’t admissible in court. The only person qualified to read radiographs is a dentist and I was the only one there. My attorney stated that they could request an adjournment to a future date so that they could produce an expert witness (dentist) to back up this claim. So they decided to do that.
Court Date #2
We reconvene a couple of months later and I have to take another morning out of my office. The Johnsons showed up but (surprise!) they couldn’t get their new dentist to come in and testify on their behalf. So we get sworn in by the judge and start the party.
My attorney asks me a series of questions that help me tell my side of the story. Thanks to good record keeping, I’m able to explain the series of appointments and show the list of copayments that justify the $280. Then the Johnsons present their case. They run through the lame reasons I listed above and I shoot each one down. The judge nods as I defend myself and it’s looking good for our side.
Then we get to the best part. Apparently the Johnsons were counter-suing me for $4000 in grief and lost wages for tooth # 3 that needed an RCT. Really? REALLY? Well I showed the judge the patient record which clearly explained that he was told that might happen and that I was trying to be conservative. That was the last nail in that coffin for the judge. She dismissed us and later sent notice that she had ruled in my favor.
Lessons Learned
(1) The value of writing good notes in the patient record was reinforced BIG TIME after this adventure. I don’t write long narratives but I do include those important details about treatment alternatives, patients understanding potential complications, patient refusals, and so on.
(2) In New York State, the defendant can be held accountable for collections agency/attorney’s fees as long as it was part of an office financial policy that the defendant has previously signed. I have a clause in my Consent for Services that reads: “Patient is responsible for all fees accumulated if account is sent to collections.” That means the Johnsons don’t just have to pay the $280 that they owe my practice, they also have to pay the $150 or so for my attorney’s fees. Hooray for New York!
(3) Would I take another patient to court? Maybe. If I had a solid patient record and it was clear that the person was skipping out on the bill, then yes. If there was some genuine misunderstanding, my notes weren’t great, and/or the disputed amount wasn’t very much, then I guess I wouldn’t. I love my patients and the vast majority are sweet, honest people. It would take a special kind of person for me to want to chase them down for money. And it’s not really about the money, it’s about the principle. Which leads me to…
(4) There were four other cases being heard that second court date that involved dentists sending their former patients to collections. This is not an isolated incident. And the dentists couldn’t show so the case got dismissed in the patient’s favor. It bothers me that some people think they can skip out on paying the bill for services rendered. And it bothers me that we just let it go. I don’t have a good answer on how we can change the public’s perception of paying for dental services. But in the mean time, maybe you’ll consider taking patients to court when appropriate.