The former are welcomed. The latter present a threat and a burden to a private practice which does not have the privilege of not paying its bills or meeting its payroll.

I can completely understand the reluctance to take on a patient who shows indications of being unable to meet their payment obligations. “Need” notwithstanding, no one should think themselves entitled to charity or lenient terms, but too many do. I had one patient who ran up a big bill in my practice come back for more services and when asked for payment of her arrearage become angry because she expected that because her payment was so far behind she expected us to have written he charges off by that point. As if just not paying for a long enough time was somehow a way to make her obligations go away. As if the accounting treatment of unpaid charges somehow equated with some change in obligation to pay. Incredible.

It has been a very long time since most patients routinely were expected to pay all of their charges at time of service, and few really understand that credit from their doctor is not an automatic entitlement.

This happened to me when I brought my father from out of country to the doctor. My PCP doctor that did not look at the insurance, treated us in the same rushed way as any other patient even though he was paid much better. The staff treated us like second-hand people. Finally the cardiologist asked about the insurance and treated us accordingly: advised against any expensive testing, explained why this is not necessary, and waived his fee. We still had to pay the administration/hospital fee and we waited forever for the doctor to see my father, but it ended up well.