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How to Avoid Patients Walking Out on the Bill

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One of the most common questions and concerns I read online from dentists and their staff revolves around collecting payment from patients, especially those who complained about or walked out on the bill after the treatment was completed. Obviously, this can be a huge emotional rollercoaster after you spent the time and effort to provide the care, only to basically be told by the patient that it wasn’t worth it. And to make a difficult situation worse, refusal to pay is often followed up with threats by the patient of negative online reviews, complaints to the insurance company, or even reports to the state board.

Understandably, this dynamic can be a major problem for both the dentist and the team members who must deal with an unreasonable, or even hostile patient. No one in the office wants to be yelled at, and discussions of money are those most likely to end in heated words.

Thankfully, the solution to this problem is quite simple.  


Collecting money before treatment is rendered will solve most collections problems. It’s much easier to complain about something after you have had it done and before you pay.

There are a few concerns I commonly hear when an office contemplates requiring upfront payment, so let’s address each concern:

What will patients say?

Think of the alternative: If a patient is going to complain about the price before treatment, can you imagine how much more they will complain about it after? You cannot change the fact that some patients will complain about price no matter if you are talking about $1 or $10,000. Those who work in the front know this well, some patients are just a pain when it comes to money. This conversation is always easier to have before treatment is rendered.  

Roleplay with your team so they can feel confident answering patient questions. Each office or team is going to have verbiage that best fits their style, but here are some starter suggestions:

“Our patients prefer to be able to leave immediately after their treatment, so we take care of all the paperwork and finances up front.”
“Our goal is to make sure there are no surprises, which is why we always handle financials first.”

If you have someone push back, you can always try something like this, and then address the concern.

“Please help me understand why it is important to pay in one hour rather than now?”

When my office made this change, we had a lot of fears about how patients would respond. Those fears have been shown to be mostly unjustified. Most patients did not care (paying at 9am vs. 10am is the same, they are still going to pay the same amount).  

In recent years, we changed our policy to requesting payment at the time of scheduling. We still had very few complaints. What we realized is that many of our fears were our own fears, not our patient’s. Don’t let these fears hold you back from being more efficient and finding ways to prevent the common problems in a dental office.

What if they need financing?

The average American has not saved specifically for dental expenses. It is not high on their list of preplanned expenses. Financing is a common necessity for dental care. Just make sure that you can offer and/or obtain clear financial arrangements up front and signed prior to initiating treatment.

What if treatment changes?

Providing crystal balls is not part of dental education (or maybe I missed that part). There are situations in which treatment needs might change. More or less work may be needed than expected once we get into the surgery. The solution to this is to understand what happens either way afterwards. If you overestimated treatment and the cost goes down, patients tend to be quite happy, and the dentist can be seen as a hero. If you underestimated treatment and more treatment and cost is needed, you can anticipate that you are far more likely to have an upset patient. The solution is simple when you look at it this way.

When in doubt or on the fence about what treatment may be needed, always overestimate the amount of work and cost necessary. Example: If you think the tooth may need a root canal, plan for it.  

Set yourself up for success and to be the hero instead of the collection agent. If you collected more than needed, great, now the patient has a credit you can leave on the account or refund. Refunding money is far easier than collecting balances!

What about insurance only being an estimate?

Most people will clearly remember the price you quoted, but not the word “estimate.” Expect that as the norm. So, to ensure the most favorable outcome for both parties, it comes down to the same principle as if treatment changes. If you aren’t completely certain insurance will pay for something, estimate that it will not. This way you can always be seen as the hero and not the villain.

“Insurance paid more than they told us they would pay; this is awesome for you! What would you like to do with that credit?”

Now you will still have some patients complain about price up front, great, this is when you can discuss alternative options. Possibly less expensive options. Then they have a choice to make between two treatment options; let the patient make the determination whether they would prefer the more effective and longer lasting option or to spend less money on a less effective treatment option. As you can imagine, if the patient does not have this choice up front, they can be quite upset after. “I would not have done this treatment if I had known it would cost so much (out of pocket).”

Often in healthcare we try to avoid objections from patients, but this is the worst approach we could take. Objections help us understand the patient’s goals and priorities. When we know their objection, we can also provide alternative solutions. When we avoid surfacing objections, we miss out on the opportunity to address them. You can bet the patient’s objections aren’t naturally going to go away when they go home. If anything, they are likely to come up with more.

It can also be helpful to understand that when patients complain about fees, they may not be complaining about you. You can always empathize with a patient’s concerns even if you do not share them.

No matter the patient’s situation, it is always easier to have these conversations before treatment is rendered instead of after. We cannot repossess most dental care, but the goal of handling finances up front is for the patient’s benefit. It helps with communication, helps the patient make an informed decision, and prevents the worst collections problems from happening. It is much harder for someone to like you if they owe you money. Don’t put them in the situation. You will have happier patients and a less stressed team.

Patients literally cannot walk out on the bill if you have a system to collect money before treatment is rendered!

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