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“You can get past the dead end. You can break through the ceiling. I did and so have countless others.”

Patient Refunds In The Nurse Practitioner Practice

Money Currency Us Dollars  - Peggy_Marco / Pixabay

Dealing with patient refunds can be frustrating… Trust me, I know… I have had to issue refunds on everything from a $10 supplement to an entire year’s worth of testosterone replacement therapy in my subscription-based men’s health program. Even after doing this for years, it still bothers me for some reason, but it is getting better.

I remember when I first got started how issuing a refund would aggravate me so much! I would have all kinds of questions going through my head.

“Did I not provide good enough care?”

“Did the patient not feel better?”

“Am I not providing enough value for the price?”

“Did they find somewhere cheaper?”

And so forth…

But I quickly learned to just accept this as a fact about ALL BUSINESSES:

Refunds are just part of doing business! EXPECT IT!

So, the question that begs to be answered is: how do you deal with patient refund requests?

There are many trains of through amongst business owners on how to deal with refund requests. The most common policies are:

No refunds whatsoever.

Refunds can be permissible under certain circumstances.

Refunds are always permitted if it is the businesses fault.

Refunds are always permitted no matter what.

Which one is the right one? Which one works best for the nurse practitioner niche practice? There is no right or wrong answer here. Do what works for YOU, but I will give you my opinions on the above policies and tell you what we do.

Policy #1: No refunds whatsoever: In my opinion, I think this is bad business. I understand that once the patient is issued the prescription from a compounding pharmacy or dispened/injectioned from your practice, then your business is at a total loss. You cannot accept back the medications issued from the pharmacy, dispensed from your practice, or given as an injection. You just can’t. This train of thought revolves around this issue. Again, guess what? Sometimes you lose money in business. Welcome to operating a business. Here is why (in my opinion mind you) having a “no refund whatsoever” policy is bad for your business:

  • If a patient feels like the medication was a waste of money because it did nothing for them, is asking for a refund, and you totally refuse it, guess what is going to happen? A 1-star Google review and them badmouthing your practice every moment they can get. Is that really worth the $100 loss? I think the negatives outweigh the money you lost. A 1-star Google review WILL turn away future patients. Now you lost even more! Think about that.
  • If you refuse refunds, you just lost that customer for life. Sometimes it is best to just provide the refund because you can then provide a different service. Sure, it is a break even but guess what? NEXT MONTH IT WILL BE A PROFIT. So, always be forward thinking on this.
  • It can turn off future patients to begin with. I can’t stand going into a business and seeing the “All business is final!” or “No refunds!” posted on the wall or next to their register. Often, I won’t even bother purchasing anything from a place like that. What if I am not satisfied? I am SOL? No thank you…

Policy #2: Refunds can be permissible under certain circumstances: Sometimes treatment doesn’t work. Sometimes patients have a bad reaction. Sometimes patients just need a refund because they are generally not satisfied with your services. In my opinion, if a patient verbalizes dissatisfaction, then they should receive a refund to avoid the bad press that can come from angering them. Other times, patients can just be assholes and want a refund just to have a refund. And in those instances, I tell them “NO!” So, how do you decide what circumstances are permissible for a refund, especially when it comes to medications/supplies that cannot be returned and your practice is at a financial loss? Ask yourself this question:

Is the financial loss worth the possible bad reviews and bad press if I anger this patient?

Also, put yourself in the patients’ shoes for a moment:

If a patient has a localized reaction to an injectable medication (semaglutide, testosterone, etc.) and cannot tolerate it, then should they REALLY be out of the marked-up price on your end? Let’s take semaglutide for example. Yes, I know, it is expensive stuff. If it cost your clinic $150 for a vial and you charged the patient $350, don’t you think you should AT LEAST give them a refund on the $200? By doing this, you not only covered your expense, but you potentially kept the patient to try another weight loss medication on. The patient might have limited funds and struggling to even see you. Try to be compassionate sometimes. This is just called being a good business owner who truly cares about their clients.

You just need to take each situation as it comes. It can be difficult to have a policy for every single situation, therefore just have some general policies for common refund requests and others that require YOUR SPECIFIC PERMISSION. At my men’s health clinic, we rarely issue refunds because refund requests don’t come around often (men feel better!). Therefore, every refund request must come through me for approval UNLESS it revolves around an erroneous charge on our end. Then my medical assistants can issue it to them without my permission. Otherwise, certain circumstances deserve a refund in my opinion and other circumstances DON’T! You just need to take each one as they come.

Policy #3 Refunds are always permitted if it is the businesses fault: Feeding off the above example at my men’s health clinic about an erroneous charge and a refund, I believe that if it is your fault as a business, then you should offer a refund. Many errors can occur within the niche practice:

The wrong medication was ordered from the compounding pharmacy.

Duplicate charges.

Erroneous amounts charged at checkout.

And so forth…

Listen, if it is your business’s fault, ISSUE THE REFUND. This is just good business and there should be no questions asked about this policy.

Policy #4: Refunds are always permitted no matter what. There are many businesses that THRIVE on lifetime guarantees and refund policies. Why? Because it increases sales at the point of contact. If people see a lifetime guarantee or a “no questions asked” policy about refunds, then customers are willing to take a chance on your service or product. Therefore, there is a marketing strategy here with a “refunds always permitted no matter what” policy!

Imagine having on your niche practices website a statement that says, “Your satisfaction is 100% guaranteed or your money back!” Now imagine having a patient that is visiting your website that might be on the fence about calling you to schedule an appointment. If they see that statement, then their mind might become at ease.

Remember, one of the biggest reasons why conflict happens in a business is because of money. Patients can be skittish about handing you over their hard-earned cash, especially when they have health insurance. Therefore, consider having this policy if you are struggling with acquiring patients. Don’t worry too much about it, you will not get many refund requests if you are providing value and excellent customer service.

In my opinion, I think Policy #2 and Policy #3 are the ways to go. Every circumstance surrounding a refund request should be looked at as different, outside of when it is the business’s fault that a refund is being requested though. Every patient’s circumstance is going to be different. Every refund request circumstance is going to be different. The key here is to just be a GOOD PERSON. Try to see it from the patients’ eyes.

We recently had a patient request a refund on their 12-month payment for services at my men’s health practice 3 months into treatment because he “found somewhere else to go.” In this case, I said NO. Not out of principle, but because the way he was acting about it. To put it frank: he was being an asshole. So instead, we defused the situation and provided 9 months of treatment with another service we offered since he was getting his testosterone from somewhere else. He accepted and everyone was happy. Again, the circumstances dictated what I did as a business owner.

Another example is when I had a patient who was allergic to every single testosterone preparation we tried. Testosterone is compounded in various oils such as sesame, cottonseed, and grapeseed oils. Occasionally, patients will be allergic to the oil. Unfortunately, he just kept having allergic reactions. We put him on topical testosterone which resolved the issue, but he requested a refund on the 3 vials we tried. I could tell the guy was not well off financially. So, what did I do? I refunded him for the 3 vials. I would rather be out $300 then lose this patient for life because I will have earned that loss back in a matter of 2 months with him staying on topical testosterone… Plus, I am helping the patient out and that is why we do what we do.

I understand you are running a business and that profit is your main goal. I TOTALLY get that. But sometimes it is best to just give the refund to your customer to avoid potential conflict in most situations. Remember, pick your battles wisely in your practice. More times than not, the conflict is NOT WORTH the $100-200 refund request. I have seen frivolous BOARD OF NURSING COMPLAINTS over a patient not getting a refund. Is that really worth $200 to you? It certainly isn’t to me! Therefore, look at the various outcomes of providing a refund AND not providing a refund. It will help you become a better nurse practitioner entrepreneur at the end of the day!

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