After a procedure at the clinic while she was still a student, she was left with a large bill that she was gradually paying. She said that she received a letter informing her of her doctor that she couldn’t attend her appointment until she had paid the full bill. Jordan’s story is not unusual. It was certainly not unique at The Woman’s Clinic where triage nurses review patient records, and sometimes interfere. Nurses notify the billing office if a patient has not paid their bill. An employee calls the patient to request payment before she can return the call. Even if the patient indicated that it is an emergency, this applies. Mississippi Today’s request for clarifications on clinic policies was not answered by The Woman’s Clinic’s clinic administrator. Experts believe that this practice may be increasing in frequency and is legal. It is not limited to this provider as demonstrated by the testimonies of multiple women who spoke with Mississippi Today about their experiences at other clinics. Roy Mitchell, executive director, Mississippi Health Advocacy Policy Program said, “My understanding is that there’s no common-law duty or any ethical imperative other than the Emergency Medical Treatment and Active Labor Act, which applies only to hospitals),” which requires a physician treat every patient. Mitchell stated that the problem has been brought to the forefront by rising healthcare costs and the additional complications of insurance reimbursements. Mitchell asked, “Do doctors have a duty? He said that physicians have a duty to treat, but it is only on a professional and altruistic basis without any legal force. In a statement to Mississippi Today, Ken Cleveland, executive director of Mississippi State Board of Medical Licensure stated that it was impossible to determine if there were any violations without an extensive investigation. The Board is not usually involved in billing matters. Cleveland said that the Board might be interested in investigating the circumstances described by Jordan and other witnesses if a formal complaint is filed. Charles Miles, who was the Board of Medical Licensure’s past president, was more open to discussion. After hearing the stories of patients, Miles stated that “that’s not right.” After hearing the stories of patients, Miles said that she was in OB-GYN (obstetrics & gynecology). Endometriosis refers to a painful condition where tissue that is similar to the lining of the uterus expands outside the uterus. Jordan was just a teenager when her doctor recommended a contraceptive to help control the growth and pain. Jordan was a college student and had a part-time job. She couldn’t pay her clinic bill after she had two more surgeries. In 2017, she had her laparoscopy. One day, her doctor sent her a letter via certified mail to her home. She was shocked by the delivery method. She was told that she could not attend her scheduled appointment if she didn’t pay her balance. She was expecting to be able to refill her prescription at that time. Jordan, now 26, stated that she called the office to tell them, “Look, I cannot stop my contraception — (my doctor has me on a specific birth control that does not cause my endometriosis to flare), and I can’t stop taking it.” Her doctor had also given her an antidepressant after her father’s passing — another reason money was tight at the time for her family. The clinic employees refused to offer Jordan a payment plan, and told her that she had to pay the entire balance to continue to see her doctor. Jordan claimed that she wrote a letter to her doctor and sent it by mail. She never heard from her again after several weeks and days. Although she eventually found a new OB/GYN, it took a while before she could see her. She was forced to stop taking the medication she had been using since middle school. The endometriosis got worse, as expected. She said, “I was in severe pain as soon as I got in to the new doctor.” They finally scheduled my surgery. “I was in such severe pain that I missed classes.” The policy remains in effect at The Woman’s Clinic. This is an independent private practice that rents space from Baptist Memorial Hospital. The hospital is used for patient admissions. Jacqueline Rudder of Madison was also shocked when she called her doctor in a medical emergency in January 2022. As the prompts on the phone told her, she dialed “1” to signal that she was in an emergency. She also left a message for the nurses. She said that she received a call from the billing department of the clinic within minutes. Rudder stated that the lady said to her, “You can’t talk to a doctor, or a nurse, until you settle your balance.” “I didn’t know about the bill at that time and would have been happy to pay.” Rudder later found the bill in her mail. It was $51 with no payment due date. Rudder called the billing department the next week to inquire why this had happened. Mississippi Today was able to obtain a recording of that call. A billing employee explained to Rudder that this is their procedure. In a robotic voice, the employee explained to Rudder that she must try to pay the balance according to their procedures. The clinic has had similar experiences with several other patients, some of whom requested anonymity because they were not named. One woman tried to book an appointment for a procedure her doctor had recommended in December. She was told she had $500 remaining and that she couldn’t make the appointment until she paid it. She said that she had asked billing to help her figure out a way to pay $100 per month or half the bill. But they refused to do so. A former patient of The Woman’s Clinic was placed on bed rest in her first trimester. One day after she began bleeding in January 2019, she called the clinic. Although she had notified the clinic about a change in her husband’s insurance, the clinic did not return her call until billing. She said that her OB’s nurse called her hours later and she had me come in the following day. A former patient discovered a lump in her breasts five years ago. Her family had a history of breast cancer. She also lost her grandmother to it. In panic, she called the clinic. She recalled that she called the clinic to make an appointment. “I don’t remember who it was but they said, “Hey, you owe us a balance. We can’t see and you can’t talk to a nurse or doctor until we pay the balance.” “Another doctor basically told me that I was blackballed from all of the practice until I paid.” She stated that she then decided to go find another doctor. According to women who have been at OB-GYN or other speciality clinics, The Woman’s Clinic isn’t the only one that has these practices. Rudder shared her story about what happened at The Woman’s Clinic to a mom’s Facebook page. Rudder received around 100 comments. Some of these comments echoed Rudder’s experience. One patient of Women’s Health Associates in Flowood said that during her visits to her doctor while she was pregnant with twins in 2016, she was frequently directed to the billing department before being allowed to return to her room to see her doctor. She was experiencing extreme pain in her C section incision shortly after giving birth and she made an appointment with her doctor. She recalled that “right away when I arrived, they sent me back into the room, and I was so mad, because I was experiencing so much pain.” “I felt like nobody was listening to my pain.” She said that the bill was less than $100, and she didn’t have to pay it, but she needed to go to her doctor to get it paid. She said that her doctor performed an operation to relieve the pressure in her incision. Women’s Health Associates representatives said they couldn’t comment on this specific case because she didn’t know the identity. “If a patient is in need of care and has a balance, we speak with them about payment arrangements,” stated a clinic administrator. She hung up before the reporter could get her name. “But, if someone’s in pain we’ll take care of them first.”