Nearly every doctor we know has encountered a patient who can’t afford to pay, refuses to make co-pays, or promises to grab their checkbook – only to hightail it out of the parking lot.

Outside of the exam room, it’s one of the most challenging – and delicate – situations eye doctors face. Here are a few tips of managing them:

It all starts with the front desk. Some patients just don’t understand that even with insurance, they’re responsible for some of the bill. Make sure your staff informs patients that co-payments are part of the patient’s insurance contract. This could help patient’s understand that your practice isn’t charging them a fee on top of insurance.

Manage expectations upfront. Are patients insured? Do you accept their insurance? Many practices already do this, but we recommend informing patients up front about the exact costs of the visit. In most cases, it can help you avoid performing an exam or procedure at a loss.

Give them a ready-made envelope. When a patient can’t pay the day of the appointment, hand them a pre-stamped, pre-addressed envelope before they walk out the door. According to Family Practice Management, one practice receives nearly every envelope back within two weeks.

Create a payment plan. Whether it’s $50 for a few years, or $100 for five months, even patients who aren’t struggling financially may prefer to pay for pricey procedures over time. Want to stay out of collections and minimize risk? Recommend a third-party lender to patients.

Put a policy in writing. This way, patients must read and acknowledge crystal clear policies that outline accepted payment methods (from cash to credit cards) and their responsibility for all unpaid balances after insurance is paid.