One benefit of adding cosmetic dermatology to a practice is that procedures are usually performed on a fee-for-service basis, rather than relying on ever-diminishing insurance reimbursements for medical dermatology. It all sounds good, but what happens when a patient doesn't plan on paying in the first place?
It all sounds good - being able to charge an appropriate fee for your time, talent and skill - but what happens when a patient doesn't agree with the bill? What happens when a patient never really plans on paying that fair price in the first place?
Some patients charge the procedure to a credit card and then cancel the transaction after leaving the doctor's office. Doctors who spoke to On Call say they can usually work out a disputed charge with most credit card companies because they have papers signed by the patient, but if a patient is determined, they employ a variety of methods to avoid paying.
Dr. Zuckerman, a consultant for Long Island Jewish Hospital, says it quickly becomes obvious when bad checks are not simply an honest mistake.
"I'll tell you how. We've called, and the person on the phone will say, 'That's not me,' even while we recognize their voice. Or we've called before, but the day after the appointment, the phone is disconnected, so we know there's a method to the madness."
In Greenbelt and Chevy Chase, Md., Eric Finzi, M.D., Ph.D., says he hasn't been scammed often, and he can laugh - almost - about the first time he was.
"I tend not to be suspicious of anybody who's older because that's just not the kind of behavior one expects from some dignified, lovely, gray-haired 70-years-of-age person," he says. "A very upstanding-looking woman asked me to do some cosmetic procedures. I did several things right then and there - Botox, fillers. She wrote a check to cover the bill and shortly thereafter, I found that she stopped payment on the check.
"It wasn't a huge sum, but it was more than $1,000," Dr. Finzi says. "I was quite surprised because I've had people bounce checks, come back and make them good, but this was definitely premeditated. She specifically stopped payment. We tried contacting her, but finally just gave up."
John Binhlam, M.D., in Brentwood, Tenn., says scams in his office have been much less elaborate.
"A couple of scenarios I remember include the lady claiming she left her checkbook out in the car and saying she would run out, get it and be right back. She hasn't come back yet. It's also happened that people have credit cards declined after the procedure, so they leave to get their checkbook and don't return," he says.
In practice for 15 years, Dr. Binhlam has also seen checks written on closed bank accounts. "But to be honest, that has happened with our regular medical patients too, as well as cosmetic patients. We've tried going after the money and turned things over to a collection agency. Sometimes that helps; other times it doesn't and we just eat that cost.
"These patients do come in with the intent not to pay because they give us numbers we can't trace, or a closed account," he adds. "These aren't patients we've had a relationship with over a number of years."