Scenario One: An 86-year widow comes in monthly to have her blood drawn and monitored ever since her heart attack 2 years ago. Her husband has recently passed away and she has no family nearby to help her. She has Medicare but does not have supplemental insurance to cover office visits. When leaving the office today, she starts to cry and tell you that she can no longer afford her blood pressure medications, cholesterol medications, blood work, and office visits each month. She will not be able to get her medications refilled unless she sees the doctor and has blood work each month. She currently owes $180 on her account today.

Scenario 2: A 19-year-old mother of 3 children, all under the age of 5, brings in all of the kids today for their recommended check-ups and vaccinations. She does not have insurance for any of the children as she was denied Medicaid based on a previous fraud. She has been diligent paying for the children's healthcare, with assistance from a grandmother, but she recently passed away. After today's visits, she tells you that she only has enough money to pay for services for two of the kids, but not the third one. This mother has been known to cause scenes and be disrespectful to the office staff, and you know that if these children are discharged from the office, they will have a hard time being accepted at another provider due to the mother's behavior.

1. How would you handle each of these situations?
2. Is one scenario worthy of breaking the official rules? One more than others?
3. If you must discharge these patients for non-payment, what advice will you give them?