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When Do You Talk to Patients About Outstanding Balances?

Originally posted on Please visit their site to login and view the original article.

If you read patient complaints on the internet about dental offices, the thing they are most upset about typically has something to do with money, insurance, or financial situations. The way this process works is we estimate what the insurance will pay for a procedure, the patient pays their portion, and then the insurance comes back paying less than expected. Regardless of how much your office does on the front end to try to avoid this situation, it cannot be fully avoided and happens regularly.

Patients are understandably upset when presented with an unexpected balance and, of course, it does not make the dental office happy either. When this scenario happens, the patient tends to get upset with the office and the team takes the brunt of the frustration from the patient.

A one-time occurrence based on a single appointment is relatively easy to handle. The dental team can talk the patient off the ledge because it’s obvious that it was the insurance company’s response to the claim that caused the unexpected bill. The EOB shows the patient that insurance did not pay what your office expected, putting the responsibility back onto the insurance company than on the office. The real problem begins when the outstanding balance continues to grow, when either the patient or a family member on the account continue to get additional treatment. When the patient finally realizes they owe a large outstanding balance, they get frustrated at the size of it and now become frustrated or angry at the dental team.

We want to ensure we stay on top of patients’ accounts so we can collect as accurately as possible at the time of service. However, there are many times that does not happen. When a patient ends up with a balance after the fact, the goal is to rely on the effective systems in place to collect from the patient before they accumulate an even bigger balance.

Here are the three best times to talk to patients about their account:

1) When statements go out.

Statements go out as soon as the EOB is received and we are not expecting any more from insurance. The statement then goes out each month after that until the patient pays (or until they avoid payment long enough they go to collections). Patients may pay the amount due when they receive the statement or they might call in and want to know more about the balance. The financial coordinator should review the accounts and determine where balances come from, call the patient to explain, and attempt to collect during that call. She or he should put in notes clearly explaining why the balance exists and the result of the call attempting to get the patient to pay.

The worst thing that can happen at this point—but sadly, this does happen on a regular basis in most dental offices—is the patient hears conflicting information from multiple members of the dental team. Imagine that a person on the team tells the patient one specific reason that they have a balance, let’s say the deductible was applied. The next time the patient talks to a different team member and gets a different answer, maybe that the insurance downgraded. With two responses that don’t match, the patient now starts to question whether the dental office even knows what they are talking about, doubts the balance is accurate, and ultimately pushes back on paying it.

Not only does this result in failure to collect the balance, it can also make the patient feel so unhappy with how billing was handled that they decide to leave the office. The patient’s perception is that the dental office, not the insurance, is to blame for this outstanding balance.

2) When the patient is scheduled for more treatment.

Many times, patients require more than one visit for their dental treatment. Between appointments, the insurance claims are paid and there is a balance left for the patient. Instead of letting the patient balance continue to grow through additional treatments, we need to collect on the previous balance along with their expected out-of-pocket before they have more dentistry completed. The scheduler should discuss outstanding balances with patients in the doctor’s schedule as she confirms patients so they understand their expected payment amount, including any outstanding balance. The scheduler should add information about this conversation in the appointment and account notes so everyone on the team knows to collect the full amount.

3) When the patient is scheduled for cleaning or perio maintenance.

If the patient has not come into the office since the final insurance check was paid on their account, oftentimes the balance sits unpaid until their next appointment with hygiene. This is an important time to discuss the balance with the patient and collect on it, because we now only see the patient once every 3, 4, or 6 months.

Patients are more likely to pay when they are in the office versus the months between visits.

The hygiene scheduler should discuss outstanding balances with patients in the hygiene schedule as she confirms patients and make them aware of the full amount they are expected to pay at the time of the confirmed appointment. She should put this information in the appointment notes and the account notes so anyone checking out the patient will know about the discussion and the amount due. If the patient has an issue with the balance over the phone, someone should include instructions to put that patient in the consult room at end of appointment to discuss their balance with them.

Regardless of which point along the way a team member speaks with the patient about their balance and how they intend to pay, notes MUST be put into the patient’s chart so there is a record of the conversation. Patients tend to get frustrated when they must tell their story multiple times because a dental office team does not keep good records of the communication. When there’s no record of previous conversations with the patient about their balance, the chance of collecting the unpaid balance owed drops significantly, as patients would prefer to forget that they owe the office money. It is our job to make sure they are reminded about previous discussions and make clear it is our intent to collect the balance.

The best opportunity to discuss the balance face-to-face with the patient is when they are in for an appointment. The morning huddle is the best time for the team to review patients with balances and make sure they know who needs to pay that day. If the patient has a concern, question, or issue with the balance, bring them to an area in the office where someone can sit down with them and help them work through it. It’s vital to recognize that people do not like to spend money on dentistry and will avoid paying for it if possible.

Since we only see some of our patients a few times a year, it’s important to get the right systems in place to help eliminate the chance of outstanding balances lingering or growing over time.

Laura Nelson

Laura Nelson, BS, MS, FAADOM is the founder and driving force behind Front Office Rocks, and the leading provider of on-demand virtual training and resources for dental practices.