Aubree Jordan from Madison has suffered from endometriosis since she was in college. She was a regular patient at the Woman’s Clinic in Madison and saw her doctor up to five times a year.
But after an operation at the clinic when she was a student, she had to pay a bill which she slowly paid as best she could. Before she could, however, she said she had received a letter from her doctor saying she could not come to her next appointment until the bill was paid in full.
Jordan’s experience was not unique — and certainly not at The Woman’s Clinic, where triage nurses review patient records and play interference. If the patient has an overdue bill, the nurses alert the billing office, and an employee then calls the patient and requests payment before a nurse can return the call. This is true even in cases where the patient has indicated on the phone prompt that their call is an emergency.
The administrator of The Woman’s Clinic did not respond to Mississippi Today’s requests for clarification on the clinic’s policies.
According to experts, this practice is not illegal and may occur more and more often. And it’s not just limited to this provider, as evidenced by the testimonials of several women who have spoken with Mississippi Today and use other clinics.
“I understand that there is no common law duty or even ethical imperative outside of the Emergency Medical Treatment and Active Labor Act (which only applies to hospitals) that requires a doctor to treat every patient,” said Mississippi executive director Roy Mitchell. Health Advocacy Policy Program, which works on health policy issues and advocates for consumers, especially low-income consumers.
But rising health care costs and the added complications of insurance reimbursements have brought the issue to the fore, Mitchell said.
“Do doctors have a duty to treat? Yes, but only on a professional and altruistic level without any legal force at this stage,” he said.
Ken Cleveland, executive director of the Mississippi State Board of Medical Licensure, said in a statement to Mississippi Today that it would be impossible to determine whether a violation occurred without a full investigation.
“Generally, the Commission does not get involved in billing issues. However, the situation you described (the experience of Jordan and others) may warrant further investigation if a formal complaint is filed,” Cleveland said.
Charles Miles, the former chairman and current member of the Board of Medical Licensure, was more forthcoming.
“It’s not true,” Miles said after hearing the patients’ stories. “I was in OB-GYN (obstetrics and gynecology), and that’s not how we do things.”
Endometriosis is a painful condition that occurs when tissue similar to that which normally lines the inside of the uterus grows outside of the uterus. When Jordan was a young teenager, her doctor prescribed her a contraceptive that helps control tissue growth and the pain associated with it.
But after two surgeries over the next few years, Jordan, then a full-time student with a part-time job, struggled to pay her bill at the clinic.
One day in 2017, the same year she had her laparoscopy, she received a letter from her doctor by registered mail to her family’s home – and was surprised at how it was delivered.
The letter stated that unless she could pay her balance, which she remembers as being less than $2,000, she would not be able to attend her next appointment. She expected to get refills of her prescription during this visit.
“I called them into the office and said, ‘Listen, I can’t go off my birth control – (my doctor) put me on a particular birth control that my endometriosis doesn’t flare up, and I can’t just stop taking it,” said Jordan, who is now 26.
She said her doctor also prescribed her an antidepressant after her father’s death – another reason money was tight for her family at the time.
Clinic employees did not offer her a payment plan and said her balance had to be paid in full to continue seeing her doctor. Jordan said she then wrote a letter to her doctor and mailed it to him. Days and weeks passed and she never heard from her.
She finally found a new OB-GYN, but there was a wait before she could be seen. The ordeal led her to go months without the medication she had been taking for the illness she had had since she was in middle school.
As expected, the endometriosis got worse.
“As soon as they (the new doctor) let me in, I was doubled over in pain,” she said. “They finally scheduled my operation. I was missing classes because I was in so much pain.
The policy is still in effect at The Woman’s Clinic, which is an independent private practice that leases space from Baptist Memorial Hospital and uses the hospital for admitting patients.
Jacqueline Rudder, also of Madison, was shocked after calling her doctor during a medical crisis in early January 2022. Just as the menu prompt directed her when she called, she pressed “1 to indicate it was an emergency and left a message with the nurses station.
Within minutes, she said she received a call from someone in the clinic’s billing department.
“The lady said to me, ‘You can’t talk to a doctor or a nurse until you pay your balance,’ Rudder said. “I wasn’t even aware of the bill to the time and I would have been happy to pay.”
Later, she went to find the invoice in her mail. It was $51 and had no payment due date until next month.
Rudder called the billing department the following week to ask them to clarify why this had happened to him. Mississippi Today obtained a recording of the call, during which a billing employee told Rudder it was their procedure.
“According to our procedures, we have to try to take care of the balance before the nurse can call you,” the employee told him in a robotic voice. “Doctors offer our procedures.”
Several other women, some of whom asked not to be identified by name because they are current patients, had similar experiences at the clinic.
When one of them tried to book an appointment for a procedure her doctor had told her she needed in December, she was told she had a balance of $500 and couldn’t. not make an appointment until she was paid.
“I asked billing if they would arrange for me to pay half then half later, or $100 a month…but they weren’t willing to work with me,” he said. she declared.
Several years ago, another former patient of The Woman’s Clinic was deemed high risk and bedridden early in her pregnancy. She started bleeding one day in January 2019 and immediately called the clinic.
Although she informed the clinic of a change in insurance due to her husband’s new job, she said the first reminder she received from the clinic was about billing.
“My OB nurse called me hours later and I came the next day,” she said.
About five years ago, another former patient discovered a breast lump one morning. She had a family history of breast cancer, including a grandmother who died of it.
She called the clinic in a panic.
“I called to make an appointment, and I don’t know who it was, but they said, ‘Hey, you owe a balance, and we can’t see you, and you can’t talk to a doctor or nurse until the balance is paid,” she recalls. “Another doctor pretty much told me I was blackballed from the entire practice until I paid.”
She said she decided at that time to find another doctor.
The Women’s Clinic is not alone in its practices, according to testimonials from women at OB-GYN and other specialty clinics. When Rudder posted her story about what happened at The Woman’s Clinic on a local mother’s page, there were around 100 comments, some of which echoed Rudder’s experience.
A Women’s Health Associates patient in Flowood told Mississippi Today during doctor visits while pregnant with twins in 2016 that she was often directed to the billing office before she could return to a room to see her doctor – although she is at high risk.
Shortly after giving birth, she was in extreme pain at the incision for her C-section and made an appointment with her doctor.
“Immediately when I arrived they sent me back to this room, and I was so angry because I was in so much pain,” she recalls. “I felt like no one was listening to me about the pain.”
The bill was under $100 and wasn’t due yet, she said, but she had to pay it to see her doctor. Her doctor eventually performed a procedure to help relieve the pressure in her incision, she said.
A representative from Women’s Health Associates said she could not comment on the specific case because she did not know the identity of the patient.
“If a patient has a balance and they need to come in for treatment… We talk to them about payment terms,” said a clinic administrator, who hung up before the reporter got his name. “But if someone is in pain, we will take care of it first.”