Doctors Firing or Dismissing Patients

We've known for a long time that patients can leave a healthcare provider for a new one. But in recent years we are hearing more and more about healthcare providers who are dismissing their patients. Patients ask me frequently, "Can my healthcare provider dismiss me?" The answer is—yes it is legal and fair for a healthcare provider to fire a patient under any circumstances.

But there are also circumstances under which a healthcare provider may not dismiss a patient. And there are specific steps a smart patient will take to either try to repair the relationship with the healthcare provider who has attempted to dismiss her or in the process of finding a new healthcare provider.

When a Healthcare Provider May Dismiss a Patient

Complaints healthcare providers have about patients include everything from non-adherence to obnoxious behavior to missed appointments. When the complaints about one patient are just too much, a healthcare provider may choose to terminate their relationship with that patient for any of those reasons, and for others, too.

The reasons a healthcare provider may dismiss a patient are:

• Patient non-compliance (non-adherence): When the patient fails to follow the treatment recommendations established by the healthcare provider. (Which is why it is so important that you and your healthcare provider make treatment decisions together.)
• Patient's failure to keep appointments: Patients make appointments, then cancel them at the last minute, or don't show up at all. From the provider's perspective, that means a window of no income in addition to the fact that the patient isn't getting the help they need.
• Patient's rude or obnoxious behavior: No patient should ever be rude or obnoxious. It's a form of abuse. Just as patients should fire a healthcare provider who behaves this way, it's fair that a healthcare provider should fire a patient for such poor behavior, too.
• Non-payment of bills: Money owed by the patient, but usually not the patient's insurance
• If the healthcare provider's practice is closing: Just like the rest of us, healthcare providers close their practices. They may sell them, or retire from practice, they may die, or just close their doors.

A relatively new reason for dismissal seems to be based on the type of insurance a patient has. In recent years, patients report their healthcare providers are firing them for no apparent reason (at least they are not told what the reason is). The one thing these patients have in common is that their payers are those that reimburse providers at very low rates.

As reimbursements have gone down, the number of patients reporting dismissals from their healthcare providers has gone up. If you aren't sure why your healthcare provider has dismissed you, you may want to better understand why healthcare providers don't want to accept some insurances.

When a Healthcare Provider Cannot Legally Dismiss a Patient

There are reasons and times a healthcare provider may not legally or ethically fire a patient—most of which are based on state or federal law.

Healthcare providers may not discriminate based on race, color, religion, national origin, sexual orientation, gender identity, or any other attribute that is nationally recognized as discrimination.

The courts have ruled that a patient cannot be dismissed because he or she is HIV-positive. If you feel as if you have been discriminated against for one of these reasons, contact your state health department.

Healthcare providers may not dismiss a patient in the midst of ongoing medical care, called "continuity of care." For example, a person who is pregnant cannot be dismissed by their healthcare provider within a few weeks of delivery. A cancer patient cannot be fired before his chemo or radiation treatments are completed.

However, a patient who has been on a primary care healthcare provider's roster, but hasn't visited that healthcare provider in a year or two might be dismissed. That is not considered ongoing care.

How the Patient Dismissal Takes Place

Some states have laws that govern the process a healthcare provider should use to fire a patient. However, in most cases, the dismissal protocol is based more on ethics and responsibility to the patient than what the law may or may not tell them they must do. These guidelines are mostly intended to keep the healthcare provider out of hot water (at least) or to help avoid a lawsuit.

The best situation a patient who is being dismissed can hope for is a postal letter that provides 30 days notice, access to their medical records, and suggestions for new providers. At the least, the patient may receive no notice whatsoever.

Few states oblige the healthcare provider to declare the reason for dismissal. Some guidelines even tell the healthcare provider not to mention the reason for firing in order to avoid an argument from the patient.

What to Do If Your Healthcare Provider Has Dismissed You

If your healthcare provider fires you, you have a few options:

• If you want to go back to that healthcare provider, you may want to attempt to repair the relationship with your healthcare provider. This will involve knowing what the reason was that you were dismissed (which may, or may not, be apparent).
• If you prefer to move on to a new healthcare provider, then be sure to get copies of your medical records from the healthcare provider who fired you, then follow the guidelines for changing healthcare providers.

A couple of "don'ts" to remember as you make this transition:

• Don't get overly argumentative, obnoxious, or aggressive. It could result in you being denied medical care.
• Don't ask the healthcare provider who is dismissing you for a referral. Your better bet is to find someone on your own, someone who is independent of the healthcare provider who has fired you.
• Don't complain about the old healthcare provider. It does not move you forward and may give your new healthcare provider a reason not to engage with you as a patient.