Getting Paid for Dentistry

June 1, 2002
One of the most gratifying aspects of being a dental practice owner is independence. The years of hard work and dedication have finally paid off. For those on the outside looking in, individuals who own their own businesses are the luckiest people alive!

by Tammy L. Carullo

Can patients be retrained? It's up to you!

One of the most gratifying aspects of being a dental practice owner is independence. The years of hard work and dedication have finally paid off. For those on the outside looking in, individuals who own their own businesses are the luckiest people alive!

In the cold, hard reality of life, however, owning your own business can be far from blissful. It actually takes tremendous effort at times just to keep it afloat! What about this issue of getting paid? It sounds easy enough, doesn't it? You provide a service, and then you get paid for it. No problem, right? At least, it works in theory. Yet, those who have been through the "school of hard knocks" can confirm that providing a service and actually getting paid for it are entirely different matters.

This issue is one of the most frustrating obstacles in dentistry. by far. But let's suspend reality for just a moment and imagine that dental insurance is no longer a factor. You have no decisions to make about whether to go fee-for-service (FFS) or delve deeper into various insurance schemes. In a perfect world, patients simply would do what we recommend to them, follow through with treatment because they want to, and never question the cost of the care you provide. Sounds great, doesn't it? However, for those of us in the trenches, this definitely is not reality.

What about fee-for-service?

Many dentists think that their colleagues who have made the jump to fee-for-service, insurance-free practices "have it made." Think again. FFS dentists still often need to do battle over getting paid for their services. Doing good dentistry and getting paid for it is a challenge, regardless of the existence of insurance. Patient perception, and, more importantly, patient resistance play a critical role in when you get paid.

Some believe that eliminating insurance from dentistry is the answer, while others believe that diving deeper into DMOs will finally provide our salvation. But the reality is that we, ourselves, created the situation of not getting paid for our services. Our patients never, for example, walk into a beauty salon for hair color, cut, and manicure without expecting to pay for these services. And, when we take our kids to the pediatrician, we are prepared to pay the bill. So, why on earth do our patients assume that it's OK to come in, get the necessary dental work, and shout, "Bill me" as they scoot out the door? They do so because we have created the environment and allowed it to occur for so long that it is now a difficult, uphill battle to get them to conform to our "new" policy of payment - payment upon services rendered.

How did we get here?

It very likely started quite innocently with a patient who forgot his wallet, or a patient who had fallen on hard times and just needed a break. Now fast-forward to the present - a collections nightmare where dentists carry 60 percent of patient balances!

If you are a "participating" practice, you are obligated to accept what the insurance plan covers, which means that you will not get paid at the time of services nor can you bill the patient for any balance.

If you accept assignment, the insurance company usually pays you and then you bill the patient for any remaining balance, having advised the patient in advance. Once again, you are not getting paid at the time of services.

If you have stopped accepting insurance altogether, believe it or not, you may find yourself having far less success with collections than with the previous examples. Surprised? You shouldn't be! When a practice deals with an insurance company, yes, it can be a real pain, and yes, its claim policies do sometimes tie the dentist's hands and limit patient options, but such practices recoup more than you may think.

Keep in mind that insurance is not the "be all and end all," and neither is FFS. You have to do a little investigating - find out what will work in your particular location, and the type of patients you are trying to attract. These factors are critical in your decision-making process, and even more so in getting paid for your services.


If you have made up your mind that FFS - hands down - is the answer to your problems, there are several payment options available. One that has had incredible success is a Credit Card Retainer System (CCRS). Under this plan, each patient supplies a credit card that you keep on file in your database. On the day of the appointment, patients either bring an alternative form of payment, or the credit card is charged - having already been authorized for this purpose. It works beautifully! The tricky part of this or any newly implemented policy is your existing patient base and their entrenched resistance. If you make it your policy, however, there is no room for negotiation.

New patients come to your practice without any preconceived expectations regarding your payment policy. When they make their appointment, the CCRS is automatically activated - similar to a hotel reservation. This concept is as basic as it gets. If you make a reservation and do not cancel within the stated time limit, your credit card is automatically charged. What a solution for broken appointments! Are you tired of reserving a two-hour time slot for a crown prep, only to have the patient not show up? If you utilize CCRS, patients who repeatedly wreak havoc with your schedule would be subject to not only the CCRS charge, but an added stipulation that their credit card must be charged to even get another appointment with you!

This method gives patients a vested interest in their appointment. By providing you with their credit card information, patients are giving informed consent to the policy. If they do not agree to the policy, they simply do not supply the information. Most patients, however, are more than willing to enroll in a CCRS, at least as a backup form of payment. If they do not have a credit card - or if they fail the credit check for other payment options such as Care Credit - consider these "red flags."

You've earned it!

I frequently hear that some dentists feel guilty for asking to be paid for their services. You are providing high-quality dentistry - serving the public through prevention and treatment of disease - an extremely valuable service that requires payment to continue. There is no shame in demanding payment for your hard work, effort, and premier customer service. As a business owner, you have the right - and the responsibility - to look after your best interests and your bottom line.

However, implementing a CCRS or other payment options at the time of services does not guarantee payment unless you assume a leadership role, actually practice your payment policies, and ensure that your staff is fully on board. While being flexible might get you a "Nice Guy of the Year" award, it's not going to cover your growing overhead costs of running a dental practice.

Remember, the high-quality, premier services you provide, coupled with the fact that your patients are walking away with beautiful, healthy smiles, surely is a win-win situation - but only if you get paid!

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