A Case of Deductible Reasoning and Social Media Extortion

In this age of social media where everyone and anyone can instantly post their gripes for the world to see, we have entered a new era where our reputations can be held hostage online by patients if they don’t get what they want. Considering themselves “customers,” our patients are now starting to hold us over the coals with negative reviews as payback for a disagreement, unsuccessful treatment, and even for outstanding bills.

Recently, I heard about a patient who was seen more than six months ago in a dermatologist’s office for treatment of warts and a full skin screening who contacted the office manager to contest an outstanding balance, which was the result of the patient’s remaining insurance deductible. The patient claimed, “The doctor just looked at me! The doctor decided the warts should be treated; I didn’t know there was a charge.” Per the patient’s records, however, the patient requested treatment, the warts resolved, and nothing on the patient’s exam was suspicious enough to be biopsied. In addition to complaining about the bill, the patient made it clear that if the remaining charges were not reversed, the patient would post negative reviews online about the clinic.

The office manager and dermatologist said they were more than willing to work with the patient, until the extortion threat, which put everyone on the defensive. Noting that the previous year’s books were closed and the charting demonstrated that the patient requested treatment and that the warts were the chief complaint, there was no justification for the patient’s complaints about the outstanding balance except that the patient did not want to pay the deductible. Eventually the office manager called the patient and offered a free follow-up visit, which the patient declined. Now the staff checks their ratings sites everyday waiting for the negative review to show up—which after three months has not happened, according to the clinic.

Sadly, this form of business terrorism and extortion is nothing new—restaurants, bars, and hotels have been dealing with these issues for year. In a recent online article,¹ author Robin Shreeves exposes a trend in which frequent online restaurant “reviewers” can purchase something called a “Reviewer Card” that the consumer can then pull out at anytime to identify him/herself as a frequent reviewer. Frequent reviewers now flash this card and successfully extort free drinks or desserts at restaurants, upgraded rooms at hotels, or skip ahead in lines at clubs, all in “exchange” for a positive online review that they post from their phones on the spot or later on the computer. Of course, there is also the threat of the negative review for a business that is not complicit with the cardholder. Ms. Shreeves writes: “In my opinion, they are forming a new type of mafia, one that uses the power of social media as extortion. It’s wrong. I’m also worried that this practice will not only damage the reputations of online review sites and hurt businesses, but also damage the reputation of people like me who review restaurants.”¹

Do we now have to worry that patients are going to “negotiate” for a deductible waiver, a faster appointment, or a discount on cosmetic services in exchange for positive reviews? Do we now have to hang ourselves out and submit to predators who want free or marked down services? What protection does a small practice have against such professional reviewers who hold all the cards…literally?

In the case of the lack of deductible reasoning, the patient didn’t win this time but the unethical threat definitely got the attention of the clinic, which didn’t deserve to be in that spot after serving the patient’s needs correctly. Freedom of Speech is intended to protect us from oppression and serve in our defense, not allow us to say whatever we want about whomever we want. Maybe one day that will resonate on the ethical ears of these review websites and social media, but until then prepare to be held hostage by the secret Cabal of Card-Carrying Reviewers.