Most of us thought that our primary occupation would be that of a dentist
practice we soon realized that dentistry actually comprised only a very
small portion of our careers. We soon found ourselves engaged in
many occupations in which we were not trained, knew nothing about,
and simply weren’t interested in. We became C.E.O. of our companies,
personnel managers of our employees, accountants, psychologists,
lawyers, and bankers. Taking on all these hats has become
increasingly risky and in that I receive frequent questions from dentists
regarding billing and credit practices, this month I will review some of
these issues.

Can I charge a patient for a missed appointment?
Maybe. Generally you may charge a patient for a missed appointment if:
1. You routinely charge all patients for missed appointments and are not
discriminating against any particular patients.
2. You have given your patients prior written notice that they will be
charged for a missed appointment.
3. You have not agreed with a managed care provider or other
insurance payer to not charge for missed appointment.

An American Medical Association’s Opinion is also controlling upon
California dentists on this issue and states: “A physician may charge a
patient for a missed appointment or for one not canceled 24-hours in
advance if the patient is fully advised that the physician will make such a
charge. The practice, however, should be resorted to infrequently and
always with utmost consideration for the patient
and the patient’s circumstances.” (Opinion 8.01)

If I allow a patient to pay their balance on their credit card, can I add the
credit card fee to the patient’s balance?
No. California Civil Code 1748.1 prohibits dentists from adding the
credit card fee to patient’s using a credit card.

Can I give a discount for cash?
Yes, if you establish uniform guidelines for offering cash discounts and
offer them to all patients meeting those guidelines. For example, you
might want to offer a 5% discount to all patients paying cash on
services $1,000 or more.

What if I decide to attempt to collect overdue accounts myself?
There are many laws that apply, some of which are:
1. You may not contact the patient at their place of employment if you
know or have reason to know that the patient’s employer prohibits such
2. You may not harass patients or contact them at any unusual or
inconvenient time or place.
3. You may not contact them if they are represented by an attorney.
4. You may not use any false, deceptive, or misleading representations
in order to get them on the phone or in order to coerce them to pay. You
may not mislead them as to who you are or why you are calling.
5. You may not use obscene or profane language, call constantly and
allow the phone to ring many times, and you may not call anonymously.
6. You may not disclose the debt to members of the patient’s family,
other than their spouse, unless that patient is a child.

Can I allow a collection agency to report my delinquent patient to a
credit-reporting bureau when the agency cannot collect the amount due?
No. Generally this violates the Confidentiality of Medical Information Act.

What can I do about a bounced check?
It depends on why the check bounced.

If the check bounced due to the fact the patient stopped payment on the
check because they were unhappy with your services, you must resolve
the dispute with the patient unless you can show to the court that there
is no ‘clear and convincing evidence’ that a dispute exists between you
and the patient. Short of this difficult standard, you must attempt to
collect the fund due in other ways from the patient, or get the patient to
remove the stop payment on that check.

If the bounced check occurred because of insufficient funds, you may
pursue collection of three times the amount of check (but not less than
$100 or more than $1,500) plus your actual costs of collection. In order
to use this remedy, you must first give patient’s written notice of this
statute and give them the
chance to pay the amount they owe within 30 days.

Can I check my patient’s credit?
Yes. You may check your patient’s credit with their written authorization
assuming you following all the laws applicable to credit reporting
agencies contained in the ‘Consumer Credit Reporting Agencies Act.’
In that credit checks are highly regulated under this act, it is usually best
to use the services of a commercial credit-reporting agency.

Can I decline to provide in-office credit to patient?
Yes. However if you refuse credit to a patient under the Holden Credit
Disclosure Act you must notify that patient within 30 days as to why you
denied them credit. Failure to provide this disclosure to patients may
subject you to actual and punitive damages in an amount not to exceed

In summary, it is usually the best practice to get the money when you do
the work!
Good luck!

© Bette Robin, DDS, JD 6/98

Bette Robin                                                                                    714-421-4407
Dentist, Attorney, Real Estate Broker                                                                                                                        
17482 Irvine Blvd., Ste. E
Tustin, CA  92780