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Paying the dental bill, who is responsible?

Dentistry is a people business and because of that we want warm and friendly people answering the phone and scheduling appointments.  Extroverted, feeling type temperaments are great for building practices and making patients feel cared for and appreciated.  The downside to these temperaments is that the accounts receivables go up along with the failure to secure written and signed financial agreements prior to delivering dental care.  The ability to be warm and friendly yet firm and systematic are acquired skills that must to taught and coached.  Having a written payment policy in place is the first step in the process of learning sound collection tactics.  Presenting payment options on a document that clearly defines the patient’s responsibility to payment opens the conversation as to who will pay, when they will pay and how they will pay. All of these questions must be answered before treatment is rendered.

Let me illustrate in two different scenarios:

Case 101:  Twenty-one year old Susie Q calls the dental office with a toothache and is appointed that day for an emergency visit.  Fees are not quoted and Susie did not ask. When she is brought to the desk and quoted $125.00(by the Scheduling Coordinator, Berta), for the visit she announces that her father, who lives in another state, is responsible for her payment.  Her parents are divorced and she lives with her mother in town. The father is billed and Susie makes a follow-up appointment for root canal, build-up and crown.  Susie comes back two days later and is treated in full for the amount of $2300.00 to add to the existing bill. She has signed nothing. Her father is again billed.  At the end of the month, Berta notices that the bill has not been paid and sends another statement to Susie Q’s father.  When the bill is over 60 days, Berta calls the father only to be told that he did not give permission to Susie to incur this debt and he is not legally responsible to pay it.  No one obtained a written agreement with him nor did Susie call him.  Now Berta has to phone Susie Q and try to get her to speak to her father to work out the payment.

This common scenario takes a lot of time on the phone and in written communication.  Who is responsible for payment of this account?  Consumer credit laws change from state to state so it is important for anyone who presents financial options in the practice to understand these laws.  In general, Susie Q is twenty-one and is responsible for debts she has incurred.  If there is a legal document on file regarding child support stating that her father is to cover her dental expenses until she has graduated from college or has reached a certain age, the dental office has no way of knowing that fact.   Susie Q does not have any income so collecting the monies from her are going to be next to impossible even with the threat of ruining her credit by sending the account to collections.

Case 102:  Eighty-five year old Henrietta S calls the dental office because her denture has broken.  She is appointed that day.  She is a new patient and Dr. T says that the denture cannot be repaired and must be replaced for the fee of $1500 or for $2000 if she wants custom teeth. Henrietta wants the custom teeth and impressions are taken that day.  She signs an informed consent and a computer generated treatment plan.   She is told to pay half at her next appointment in two weeks.  Next day, her daughter, Marg, calls to complain that her mother is being taken advantage of and demands the treatment be halted as she is the appointed executor of her mother’s estate and must give permission before any work is started.  

This is another scenario that is becoming more common as people are living longer yet have to relinquish certain responsibilities such as management of personal and financial affairs to family, attorneys or other legal entities.

By using the WHO, WHEN, and HOW formula along with a written treatment estimate, an informed consent and a financial agreement form, both scenarios would have ended favorably with the practice being paid and the patients and their families pleased with the professional treatment in the practice.

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