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Why Patients Don’t Pay and How to Handle It

Posted on October 15, 2013 by Sandy Pardue

There are only two reasons why patients do not pay.

1. An Upset or a Misunderstanding

An upset patient could be caused from anything such as something was not said, or something was said and forgotten and/or not documented.


I didn’t hear him say we were doing a root canal.

I didn’t know I had to do such and such.

My insurance company doesn’t cover fluoride treatments.

These examples occur when an operative or other appointment is started and an additional procedure becomes necessary after an unplanned discovery.

Patients who are upset generally do not send in their payments. However, these problems are correctable and by doing so, removes the objection the patient has in paying. Initiating collection procedures against these patients only makes things worse by causing the patient to become more upset, causing bad public relations, making enemies and driving away families.


The rule is: When a patient (who has a good account with us) first becomes delinquent on their account, find out if there is a problem. Do this without mentioning money. It is necessary to handle the patient’s upset or problem first. When this is handled, the money problem disappears.

It is a good idea to either call these patients, or as a second choice, put a written note on the statement. You should inquire if there is any problem and let them know that you are concerned. No money or past due notice is mentioned. At this point, you are only trying to find any possible problem and clear it up. Never put any strong handwritten nudge notes, stickers or highlights on past good accounts until you have talked to them first to clear up any problem. If they always paid and stopped paying or coming in, find out what happened and correct it.


A husband and wife, with a good record of paying in the past owed an additional amount after the insurance paid. They never sent it in, which was unusual for them. The husband had received nudges on their statement because of a balance that was 90 days past due. The patient had not been contacted by phone to see if there was a problem.

He called very upset after the third nudge. After speaking with him, it was apparent that his real upset was with the treatment which his wife had received rather than the nudges. He was upset because more treatment had been done on his wife than was initially discussed and he felt that this was not fair. Once it was explained to him why the additional treatment was performed, he understood it, agreed with it and no longer had a problem paying his bill. So the moral of the story is worth repeating: When a patient (who has a good account) first becomes delinquent, find out if there is a problem. Do this without mentioning money. It is necessary to handle the patient’s upset or problem first. When this is handled, the money problem disappears.

2. Dishonest Patients

These include those who never intended to pay in the first place, those who have had bad credit histories, or those who are grossly in debt on their personal finances and hope that they can slide by with little, or no payment until pressure is put on them. This also includes those who give false names and/or addresses. This is rare, but it does happen.

The majority can be spotted by their insistence on being sent a bill, refusing to fill out a credit application or insisting on no initial payment for services rendered. These are their trademarks. They can also appear to be “high rollers”, but those in this category are definitely con artists.


The cure is prevention. Get enough information to get a credit report. This can usually tip you off if it is premeditated fraud. Then demand payment at time of service by letting the patient know in advance of treatment. It may seem like you have to be rough in dealing with these people, but what do they deserve? Just because they seem friendly with a big smile on their face or plead for sympathy, why should we give up our integrity and be fooled by their dishonest facial expression or demeanor?

Do not let them get away with their ploys. You never have to be afraid to confront them because they are in actuality more afraid than you are – they just may not show it.

For more information on this topic or to talk to me about consulting services, email me at or call me at 1-800-928-9289.


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