The Financial Policy Nobody Signed

Somewhere on your practice's website, usually on the page called New Patients or Financial Information, there is a sentence that reads something like "Payment is due at the time of service unless other arrangements have been made in advance." Most of us wrote it years ago, and it is true. The ADA's own sample financial policy says nearly the same thing, in nearly the same words. The sentence works because the person reading it is the person who will be paying. The day it stops working is the day the person in the chair is sixteen.

This is the fifth and last post in a series about that teenager. The first asked whether he may be seen at all when he arrives without a parent. The second asked who decides it is an emergency when no parent can be reached. The third was about the parent who calls afterward and what the coordinator may tell her. The fourth was about the health history he filled out alone. Those four are about consent and information. This one is about money, and the answer most practices have is sitting in a file with the wrong signature on it.

What the ADA says the policy is for

The ADA's practice-management guidance on developing a financial policy is short. "It's a good idea to provide patients with a written, formal financial policy," it says, because "Having the information in a written format ensures consistency and clarity." Then it says when: "The financial information should be presented to the patient prior to the start of extensive and expensive treatment." Then it says what to do with it: "It is also advisable to have the patient sign the financial policy form and to keep that document on file." And it says who has to learn it: "Once the policy has been developed, it's important to inform, educate and train the team on presenting and adhering to the financial policy."

Present it, have it signed, keep it, train the team. For an adult patient that is easy: the person you present it to, the person who signs, and the person who pays are one person, standing at your counter.

Three words on one line

The ADA also publishes a sample financial policy statement, one page a practice can adapt. Its first sentence is the website sentence: "Payment for services, including deductibles and copayments, are due at the time of the service unless other arrangements have been made prior to treatment." Further down: "You are ultimately responsible for all charges." And at the bottom, after "Please indicate your understanding and acceptance of these financial policies by signing below," there is one signature line, and it reads: "Patient, guardian or guarantor signature."

Three words, one blank, so that one piece of paper works for everyone. For an adult, the three words name one person. For a minor, they come apart. The patient is the teenager in the chair. The guardian is the adult who may consent to his treatment, which this series has spent four posts on. The guarantor is the adult who has agreed to pay, and nothing in the first two words says that person is the same as the third. Often it is. In a divorced family it may be the parent who does not bring him; sometimes it is a grandparent. The form does not ask which one is signing, and a sixteen-year-old holding a clipboard will sign it.

That is the financial policy nobody signed. Not a blank line, usually. A line signed by the one person at the visit who was never going to pay the bill.

Why the signature is the wrong one

Whether a minor's signature on a promise to pay would hold up is a question for your attorney, and not one you want to ask after the fact. The practical problem is simpler. Presenting a policy means a person reads it and agrees to it. The person who needs to read it is the guarantor. On the day the teenager is in your chair, the guarantor is at work. She made the appointment by phone, has never seen your financial policy, and first hears "due at the time of service" when the statement comes, by which point the crown is on.

So the policy for a minor has to answer a question the adult policy never asks: how does the practice present its financial policy to a person who is not in the building? And it has to answer it before the first visit, because at the counter the only adult in reach is the one the schedule says is coming, which may be nobody.

What the page says

The page the doctor writes is a paragraph, and it fits inside the policy the practice already wrote for the unaccompanied minor in the first post of this series.

For every new patient under eighteen, the scheduling coordinator asks one more question on the call that books the visit: who is responsible for the account. Not who is bringing him, which the first post covers, but who pays. That person's name goes on the account as the guarantor, and the financial policy goes to that person before the visit, by whatever means the practice uses to send forms ahead of time, with the signature line for the guarantor, not the patient. If the guarantor will be at the first visit, the coordinator presents it there, the way the ADA describes, and keeps the signed copy on file. If the guarantor will not be at the first visit, the signed policy comes back before the first visit, or the first visit is an exam and nothing more until it does. The desk does not start extensive treatment on a minor without the guarantor's signature in the file, and the doctor decides what "extensive" means for this practice, in writing, so the coordinator is not deciding it at the counter.

Then the sentence for the phone, because the parent will ask: "Can't he just sign it when he gets there?" The answer is a sentence the doctor wrote: the person responsible for the account is the one who signs it, and the practice sends it ahead so nothing waits on the day of the visit.

This does not create work. It moves one question from the counter, where the wrong person is standing, to the phone, where the right person is already talking to you.

Where the page lives

Saige, the team-facing assistant in AiroDental, holds the written financial policy for minors beside the rest of the practice's standing instructions, in the doctor's words. When a new scheduling coordinator has a mother on the phone booking her son's visit and asks who signs the financial policy, the answer comes back from the page the doctor wrote. When the doctor changes what counts as extensive treatment, the answer changes with it. The decision stays with the doctor. The phone call stays with the coordinator. Saige is where she finds out what the practice decided.

The financial policy on your website is fine. The one in the file, for the patients who are not the ones paying, is the one to look at. There is no long-term contract and no onboarding fee. See how Saige keeps the page where the desk can find it.

General information, not legal advice. Who may sign a financial agreement on behalf of a minor, and whether a minor's own signature binds anyone, depends on state law; confirm your policy with your attorney.

Deren Flesher, DDS. Founder, AiroDental.