I read “Getting Off the Collections Treadmill” [June 2006] by Dr. Kristen Dillon with interest. I’ve been using the approach outlined in the article for more than a decade.

I have a few additional tips to offer: If you decide to discharge a patient from your panel, be sure to notify his or her managed care plan, as notification is required in most contracts. When notifying patients that their account will be sent to collections, I send one letter requesting the U.S. Postal Service’s return receipt and I send a copy in a plain white envelope that is addressed and stamped by hand. If only the return receipt letter comes back, you can bet someone got the other letter. A wise collections expert once told me, “The people you send to collections are old pros at the collection game. They know the letter they have to sign for at the post office isn’t from Ed McMahon notifying them that they have won the sweepstakes.”

I am unapologetic about my policies. Too many patients think that all doctors are “rich and greedy.” We have to pay bills just like they do. I find it especially easy to dismiss patients who smoke and then say they “can’t afford” to pay me. They rarely see the irony of sitting in my office with a pack of cigarettes in their pocket when they say such things.