Don’t Discount The Cost of Receivables

I saw a new dentist today, Dr. Jody Low in Dover, NH. He’s a nice guy, and his office staff is pleasant, as well. Upon checkout, though, I was amused by the lack of logic behind their billing policy. If I have insurance, they expect no money from me up front. If I pay with a credit card, they charge me full price. But if I pay by check, they give me a 5% discount because (their words), they “have to pay a fee to the credit card company.” Let’s examine each of these:

  • Insurance payments mean they have to file with the insurance company, fill out various forms (online if they’re lucky, paper if not), and wait. After weeks (or perhaps a month or two) the insurance company will either reply with a check or perhaps some letter/e-mail explaining how the paperwork wasn’t coded quite right and they need to re-file. Once the check comes from the insurance company, though, it’s typically going to be for far less than the dentist bills, due to special rates the insurance company has negotiated/dictated for such a procedure. Usually a doctor will have to hire someone full-time to manage this whole process.
  • The funds from check payments typically come in within 7 to 10 days, and in probably 90% of all cases the money shows up, no problem. There are those situations, though, where the check bounces for one reason or another, causing more time and paperwork for the office to collect. Once paid, the office receives 100% of the money, discounted indirectly by per-transaction banking fees.
  • Credit card payments are charged and authorized before the patient walks out the door, and the money is in the doctor’s checking account the next day. Credit card merchant processors typically charge somewhere between 2% and 4% for this service.

Applying this understanding to my new dentist’s policy means my dentist has inferred that the best case is to wait weeks or months for — at best — 70% of the billable amount to arrive from the insurance company, all the while paying the salary of the person whose job it is to manage such things. Barring that, the next best option is to wait 7 to 10 days for 95% of the billable amount, paid via check direct from the patient. If none of those are an option, the dentist will begrudgingly get 96% of his money the next day.

Huh?

This policy (and there are many business which have adopted something similar) is based on the fact that the dentist sees that 2-4% from the credit card company and feels as though he needs to pass that cost through. In reality, the credit card payment costs him the least and nets him the most.

This is backwards. The business scenario isn’t that much different from what we deal with here at BackBeat Media. Instead of insurance companies, we have ad agencies. And while agencies don’t typically lower their rates after the fact, they do take quite a bit of handholding and red-tape-wading — and time — to get their bills paid. They always pay, mind you, and that’s the only reason we give them the terms we do (after all, if an ad agency didn’t pay their bills, they’d be out of business pretty quickly!). The rest of the companies we deal with, well, we pretty much guide them straight to the credit card path. It’s easy, it allows us to efficiently manage our cash flow, and there are zero collections costs. We pay our 2.5% and off we go.

If I could get every company to pay with a credit card, I would. And we pretty much do.

In any event, I am eager to discuss this my dentist, meaning — yes — I’m actually looking forward to my next appointment! I’ll report back if he has any wisdom I might have missed here. Until then, I look forward to hearing your thoughts in the comments below.

6 Responses to “Don’t Discount The Cost of Receivables”

  1. Glenn Fleishman Says:

    I’m about to see a podiatrist that my wife just saw. They charge $480 for new molds and orthotics, but they discount it $80 if you’re paying out of pocket and pay at the visit. I don’t know what their insurance reimbursement is, but it’s probably less than the $400 that they bill insurance.

    Some insurance companies have these weird policies that doctors can’t bill a discounted amount to ad hoc patients, because then patients would just get catastrophic insurance and pay bills out of pocket instead of getting mid-level comprehensive.

    You missed another piece of the logic. It’s not just that it costs more to collect insurance and takes longer, but rather that those of us who pay directly are subsidizing people who have health insurance. That makes no sense to me whatsoever.

    It all goes to show that health insurance and doctors’ fees have very little to do with business reality.

  2. Glenn Fleishman Says:

    I’m about to see a podiatrist that my wife just saw. They charge $480 for new molds and orthotics, but they discount it $80 if you’re paying out of pocket and pay at the visit. I don’t know what their insurance reimbursement is, but it’s probably less than the $400 that they bill insurance.
    Some insurance companies have these weird policies that doctors can’t bill a discounted amount to ad hoc patients, because then patients would just get catastrophic insurance and pay bills out of pocket instead of getting mid-level comprehensive.

    You missed another piece of the logic. It’s not just that it costs more to collect insurance and takes longer, but rather that those of us who pay directly are subsidizing people who have health insurance. That makes no sense to me whatsoever.

    It all goes to show that health insurance and doctors’ fees have very little to do with business reality.

  3. Dave Says:

    Ah yes… good point, Glenn. I’m sure you’re right that the insurance companies have some policy that dictates at least part of this.

    It just seems so *strange* to me as a business owner to follow this sort of thing, especially for a dentist where I’d wager that 50% or more of his practice has no true dental insurance.

  4. Dave Says:

    Ah yes… good point, Glenn. I’m sure you’re right that the insurance companies have some policy that dictates at least part of this.
    It just seems so *strange* to me as a business owner to follow this sort of thing, especially for a dentist where I’d wager that 50% or more of his practice has no true dental insurance.

  5. Matt Hoult Says:

    This is a very common occurrence here in Britain too. I do notice that many companies we deal with do not even have company credit cards, while those who do often know the details off the top of their heads, and are always the best clients in terms of finances.

    I don’t understand the others either though.

  6. Matt Hoult Says:

    This is a very common occurrence here in Britain too. I do notice that many companies we deal with do not even have company credit cards, while those who do often know the details off the top of their heads, and are always the best clients in terms of finances.
    I don’t understand the others either though.

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