At Nemours/Alfred I. duPont Hospital for Children, registrars use certain responses when parents object to paying at the point of service:

Scenario: The family states they did not receive an estimate letter. This is the first time they are hearing about any type of payment.

Response: “We realize you have a lot going on today. However, to help alleviate any additional stress after discharge, we try to address insurance verification and any associated out-of-pocket fees ahead of time. That way, you don’t have to worry about it after you leave. The total out-of-pocket balance determined by your insurance company is [blank]. We realize that is a large amount to pay at one time. Therefore, we only require a deposit of [blank] today. How would you like to take care of that: Cash, check, or credit card?"

Scenario: The registrar sees a note on the payment screen that reads “$300.00 paid, $200.00 due @ DOS.”

Response: “I see you already paid a portion of your deposit. How would you like to handle the balance?”

Scenario: The family is hostile when the registrar mentions the amount due. However, the prepayment note and guarantor account note state that the family agreed to pay $500 at check-in.

Response: “For this surgery, there is a minimal deposit of $500. Are you able to pay that today?” If the answer is no: “OK. The next time you schedule this type of appointment you will be requested to make a deposit prior to service.”

Scenario: The parent says, “I don’t want to pay anything until I see a bill.”

Response: “Even though you have not received a bill yet, we anticipate that you will have a balance for this service. We will be requesting a deposit toward this balance prior to time of service. By paying this deposit, you will begin to lower your final bill.”

Scenario: The parent says, “I don’t feel comfortable making a payment over the phone.”

Response: “I understand that. I can leave a note in your child’s account so that when you check in, you will be able to pay our agreed amount in person.”

Scenario: The parent asks, “Can I set up a payment plan now?”

Response: “Unfortunately, I cannot set up a payment plan prior to having a bill on the account. I can provide you with a suggested monthly payment option based on the estimated costs. Once you receive a statement from Nemours, please call us back, and we can set you up on an interest-free payment plan.”

Scenario: The parent states that his or her insurance is changing.

Response: “That’s good to know. Once you have the new information, please contact us so that we can update your insurance and see if there are any additional authorizations that will be needed. We will also be able to give you an updated estimate under your new insurance policy.”

Scenario: The parent starts to cry and exclaims, “I can’t afford this!”

Response: “I understand that, but please know that we have several options available for you and your family. We understand that this service needs to be completed and we want to help you throughout this process. Would you be able to pay 50% of the estimate? How about the deposit amount? Would you be able to pay anything at this time? Making a payment now will decrease the final bill that you receive.”