A threatening letter was the first sign that our pediatrician had chosen the wrong billing software.

The letter said there was an outstanding bill. They planned to kick us out of the practice if we didn’t settle it soon. While the office would still offer emergency care — bless their heart — until we paid, school physicals were out.

That last bit was worrisome. Whether school will be be in person or not this year, the school nurse and the state insist that kids get their checkups. Also, our pediatrician is great, and I felt bad to be complicating whatever difficulties the COVID-19 pandemic had brought their office.

But what bill? I went to the website to find out — and I could no longer log in. Reset password didn’t work. I was locked out.

Now I understand that this whole getting blocked from platforms thing is in vogue. Black creators are having videos silenced on TikTok. Apple refuses minor updates for apps that don’t give them a 30% cut. And Facebook — whatever! I’m sure Instagram is burying whoever it is that Instagram wants to bury this week. Now our pediatrician is in on the blocking game, too!

I hadn’t expected that. The pediatrician gets an app, and now they’re kicking me out of it. Everybody’s so much more fashionable than I thought!

My old-fashioned expectations of a doctor’s visit go something like this:

1. The kids go to the doc
2. I offer to pay at that time
3. But nobody knows what I owe because Insurance
4. So the doc mails me a bill
5. Which I pay
6. Profit!

This time we missed step 4, which turns out to be a big one. Without that, the rest of the process falls apart. And so, feeling even more old-fashioned, I called them on the phone.

There is no more step 4

It turns out the practice has new billing software. Bills are no longer sent by postal mail. While they do send emails to announce bills, to see details like amount or due date I’d have to log into the Pediatrician Patient Portal.

Now our pediatrician is fantastic. Even so, you can imagine my excitement at receiving an email that says there’s a message waiting. All I have to do is click the link and the log in to the Pediatrician Patient Portal. Easy!

But guess what? The practice sends these a couple times a month. Emails with no content, asking us to log in to read the actual content! Now I might have done this once, but a second click to learn that the next month’s appointment schedule has opened up — well I was gone.

And so I had missed the email that did not say that they were switching everyone to paperless billing. So I did not notice that these new vacuous email messages were now the only game in town.

Thank you for logging into the Pediatrician Patient Portal Message Center please download our app like and subscribe just hit that button below.

Policy gets local

I blame HIPPA. And perhaps software practice generally.

Both too often suffer from a lack of user-focused design. Too often we see regulatory systems designed with no thought to rewards. And nobody seems to have thought about how this particular billing system might actually work, with real patients working with what we have: decoupled internet systems like the web, email and SMS — and individual pediatrician practices.

As a policy, HIPPA can require trade offs between privacy and ease of use for both doctors and patients. But if your office implementation breaks longstanding expectations for billing, I’d argue that you’re doing it wrong.

Put the customer first

Here’s a handful of core principles for doing billing right:

1. Offer a choice of postal mail and electronic billing. Ask for consent to switch to email billing. Notify of this switch by postal mail or whatever your previous channel has been. Escalate overdue notices by postal mail and email — maybe not the first notice, but well before cutting someone off.
2. Offer autopay to paperless billing users.
3. For those who opt in to email billing, send the actual bill by email if possible. For my pediatrician, HIPPA probably prohibits sending a complete invoice.
4. Never, ever, send emails with no content. Make the content of email notifications actionable. Include enough information for the recipient to decide whether they need to log in to read the message.
   1. If you’re sending a bill, for heaven’s sake say so, and include the amount, due date and if possible a no-login link to pay.
5. Offer a messaging system on your website only as a last resort. Do this only if explicitly required by HIPPA or whatever regulation.

Behind all of these is the recognition that every contact — from appointment booking, through delivery of care, to follow up and billing — every touch point is part of your customer experience.

Let’s face it, your customers already get too many emails. They’re busy with many, many things — no matter how much they might admire your pediatrics. Work with the email or SMS they already check. Creating another messaging system on your website is not in anybody’s interest. Particularly if you’re going to lock your customers out of it before they can learn that they have an overdue bill!

Meanwhile, please tell my pediatrician I’m no longer a deadbeat.