Do You Dismiss Patients Over Money?

The typical scenario occurs when a patient receives treatment, pays the copay that was estimated and presented at the time of service, and later ends up with a balance because insurance paid less than expected. The patient then fails to respond to collection efforts.

What do you do at this point? Many practices choose to dismiss the patient. But it’s worth questioning that approach, as it often results in the office losing both the money and the patient.

The Reality

Having team members contact patients costs the office both time and money. Certainly, trying to collect small balances often results in losing more money than the potential gain. Spending an hour of team time at $25 per hour to collect a $15 balance simply does not make mathematical sense.

Sending a couple of emails or texts can usually be quick and easy, but phone calls or mailed letters/statements are a waste for smaller balances—especially when you consider that these collection efforts may deter the patient from returning.

General dental offices and specialist practices will differ slightly in this area. General dentists have the benefit of patients routinely returning for hygiene visits—unless, of course, you give the patient a reason not to return. Collecting from a patient who is already in the office is exponentially easier.

If a patient is already scheduled for hygiene or any other visit, it is far easier to manage collection efforts face-to-face. This approach can help you collect past balances while also keeping the patient engaged and returning.

Larger balances may be worth additional effort to collect; just be mindful of maintaining the patient relationship throughout the process.

Prevention Is the Key

No matter how you currently manage collection efforts, the real key is avoiding patient balances in the first place.

The goals for accounts receivable (A/R) are:

• Stay under one month in A/R
• Have 90% of A/R in the <30-day category (almost all of which should be insurance balances)
• Maintain 0% of A/R in the 90+ day category

Patient balances should be almost non‑existent, except for those set up with automatic financing. This may sound odd to some, as it might not be your current or typical practice. However, having done this for over 15 years, I can confidently say that unexpected patient balances after treatment is complete are unnecessary and almost entirely preventable.

The Two Most Common Reasons for Patient Balances

1. Collecting after treatment: Simply stop doing this—collect the money before the dentist starts treatment. There is really no excuse to do otherwise if your practice is not achieving a 99–100% overall collection rate.
2. Inaccurate estimates: This is completely preventable with proper training. Two primary causes include:
3. Incomplete or inaccurate breakdowns of benefits (whether system‑based, human, or AI-driven)
4. Inaccurate estimates due to a lack of knowledge or experience handling insurance

The most common mistake I see is that the treatment coordinator either allows the software to auto‑calculate (most practice management systems have calculation issues, especially with poor data) or subconsciously underestimates the copay to make treatment acceptance easier. Unfortunately, this tactic often backfires when the estimate is incorrect and additional money must be collected after treatment.

The solution is knowing when insurance might not pay as expected and presenting the patient with the worst‑case copay scenario upfront. Have them pay that amount at the time of service. This way, if the estimate is off, the patient ends up with a credit instead of a balance—and everyone is happier. Common reasons for discrepancies include downgrades, exclusions, non‑covered services, and denials, many of which can be avoided with improved clinical documentation.

Having a complete and accurate breakdown of benefits, along with a basic understanding of how insurance does and does not pay claims, can prevent most unexpected surprises.

Moving Forward

The ultimate goal in cleaning up A/R is first to stop it from building further. This requires improved insurance verification, more accurate benefit breakdowns, and estimating in a way that ensures any errors result in credits rather than balances.

Once the leak is stopped, it becomes much easier to address the remaining A/R. For patients already scheduled for future visits, mild collection efforts that require minimal time should be the focus. When patients arrive for their appointments, balances are far more likely to be resolved in person. Larger balances should be handled on a case‑by‑case basis, always with the goal of avoiding patient loss.

The best recommendation is to never dismiss a patient solely over money. The only reason to dismiss a patient is if the doctor intends to refuse care entirely, indefinitely. Patients who owe money are exactly the patients you should want to see again, since payment can be expected prior to services. If finances are the only challenge, dismissal is counterproductive.

In one example, a patient had a past balance of $150.80. Because she was not formally dismissed, she returned years later, paid her outstanding balance, and initiated $781.20 in new treatment—with more already scheduled. By keeping the patient, the practice was able to collect the past balance and maintain the relationship.

Keeping more patients in the practice while improving collections is a win for everyone. By fixing this internal system, you can build a healthier office and create happier patients.