How to Deal with Unreasonable Patients in Your Medical Practice

AngryA while back, I was working the front desk when a dad of one of our patients came up to me and said he didn’t want to sign the credit card on file authorization. I politely insisted he needed to fill out the auth form. He cut me off with loud: “WHY? Who came up with this stupid idea?”

Awkwardly I uttered, “Ummm, me.”

Now, both of us felt awkward. Silence…

So the parent broke the silence and in a less aggressive manner he asked why we were doing this. He asked, “…don’t you get paid by my insurance company?”

I started explaining how insurance worked. I happened to have a collection report on my desk. I showed him the bottom sum. It displayed the number that we had written off due to bad debt for the previous months before the CC policy went into place.

His draw dropped. He said “I had no idea..” he then said, “…how can you run a business when you don’t get paid right away?

“Now you know why this policy is so important to our office,” I said.

He gladly gave me his card.

In my experience, very few people will have a problem with your practice policies, whether it is collecting a charge for forms or instituting a credit card on file program. The ones that have an issue, will have less or no issue once you explain to them why you are doing it.

Let’s call these two group the reasonable parents. 

There will still be a group – a very, very small percentage of those that will continue to have a problem despite your best effort to explain your reasons.

How about if we call that group unreasonable parents? 

For the reasonable ones, continue doing what you do best. In fact, bend over backwards for this group.

For the others, the unreasonable ones, let those skeptics go free. Let them pout, yell, scream,  and complain. But don’t be afraid of them. And what ever you do, don’t let them dictate what you know is the right thing to do. Also, and equally important, don’t let those bad apples influence how you will continue treating the reasonable ones. You don’t need the unreasonable ones . Let them go.


  1. While I agree that the unreasonable ones are not worth it, in this day of Yelp and other online reviews we are risking having some terrible things said about us online–we have had that happen ( a patient who switched from a traditional insurance plan to a high deducltible PPO with HSA, then received a bill for the entire visit, and pitched a fit, not agreeing with the level visit we coded). While I know we are right, the review is still out there for all to see. I do feel at times that the threat of the negative review dictates what I do. What are your thoughts on that issue?


    • Michelle,

      You should not let the fear of a negative online review dictate how you conduct yourself in your medical practice.

      First of all, you won’t ever please everybody. So even when you do the right thing, you may still get a negative review. So what then?

      You are going to get a bad review no matter what. So don’t change what you think is right just because of that.

      Always act in the best interest of the patient while taking into consideration what is in the best interest of your practice.

      Be consistent with this and don’t worry about a few bad apples.



  2. Brandon, this is excellent. You cannot please all patients and not every patient will be right for your practice. One of the secrets is to give patients as much information before they receive any services so they have the opportunity to screen themselves out of the practice so you don’t have to. But you will have to let go of some patients.


    • Setting expectations is definitely a way to prevent miscommunications, unpleasant circumstances and surprises (the bad kind of surprises).

      And we do as much as we can in that regard. Some times better than others.

      One of the big challenges we are often faced with, is when people simply don’t assume responsibilities. Unfortunately, we can’t tell, advise, prepare, notify, anticipate every single thing that is going to happen.

      We can’t make people take responsibilities, but at the very least we can manage it. Which is one of points post makes.

      Thanks for your comment Mary Pat.


  3. Was there any discussion about WHY he was so upset? Was he concerned about who would have access to his credit card info and how the info would be protected? Did he feel he wasn’t being given the option to pay via some other method that he might have preferred? A CC on file might be convenient for YOU but patients can feel railroaded if they sense they aren’t being given any choice. Although I pay via credit card, I honestly don’t think I’d be too happy if I were required to sign an authorization giving you access. I’d like the option to say no, thankyouverymuch.

    Gotta be careful with the assumptions. Just because someone is unhappy with one of your policies doesn’t immediately make them “unreasonable.”

    As a point of interest, what do you do with folks who don’t have a major credit card or decide to get rid of their credit cards? Boot them from the practice?


    • Hello Anne,

      I think you missed the part about the patient “gladly” handing over his credit card. Once I addressed his concerns, and we addressed ours, he understood the purpose of keeping the credit card on file.

      Patients that refuse to give their doctors a credit card to keep on file are indeed unreasonable. The truth is, people hand over their cards at hotels, car rental companies, iTunes, Amazon or once upon a time, Blockbuster Video.

      For the record, patients aren’t giving us access just like a hotel doesn’t have access to a guest’s credit card when they leave a card on file for incidentals. The card is used only when we are unable to collect from the patient for their portion of the bill.

      If they don’t have a credit card, that is fine. We accept cash too.

      Appreciate you stopping by and leaving a comment.



  4. I didn’t miss that part. But I was left with a rather strong impression that he would have been deemed unreasonable if he hadn’t eventually seen it your way. And it makes me wonder how “reasonable” and “unreasonable” ought to be defined and who gets to decide.

    For the record, I think patients/families should make every effort to be civil, even when there’s a complaint or disagreement.


  5. Pamela Kramer says:

    Even though I am currently unemployed I encountered a situation with the hospital where I had a knee replacement in January. 40 days ago their computers were stolen with all identification information…probably not credit card insurance but the letter I received was implying that my SS# could of been comprised. Though the computers are encrypted I don’t know if it was an inside job. All I was offered was a free one year Experian membership to make sure my personal info wasn’t taken. So how safe is it to give your Credit card info? Unfortunately I have been paying off my balance with my credit card over the phone. I am now wondering if that is a wise choice.


    • Pamela,

      Sorry to hear about that situation you described with the hospital.

      You should always be concerned about your credit or social security number being in a place where bad people have access to it. However, most systems these days are pretty darn secure. We are nearly a cashless society. We use our credit and debit cards for many of our transactions. We can’t buy something from Amazon or iTunes without a credit card. And we certainly can’t rent a car or stay in a hotel without one either.

      So even though there is always the risk that something bad could happen, I think we don’t need to be too skeptical (some skepticism is good) of credit card programs on file.

      Thank you for leaving a comment.