> ## Documentation Index
> Fetch the complete documentation index at: https://dso.getlemma.com/llms.txt
> Use this file to discover all available pages before exploring further.

# Run patient statements and balances

> Statement cadence for dental's structurally large patient share, estimate-at-treatment-plan discipline, digital delivery and text-to-pay, payment plans, financial policies, and good faith estimates.

Patient balances make up a meaningful share of dental revenue. Annual maximums often limit plan payments to roughly $1,000–$2,000 per patient each year, major work commonly carries 50% coinsurance, and downgrades or frequency limits can increase the patient's share.<sup>1</sup> Focus on accurate estimates at treatment-plan presentation, timely follow-up, and convenient payment methods.

## Prerequisites

* Payments posted daily, with downgrade and limitation balances routed to the patient ledger; see [Post payments from 835s](/guides/billing/post-payments-from-835s)
* A signed financial policy on file
* An online payment channel
* Card-on-file authorization where you use it

## The estimate comes before the statement

Dental has a culture medical billing doesn't: the cost conversation happens **when the treatment plan is presented**, not when the bill arrives. A statement is the last step of a process that started chairside:

1. **Verify plan design as well as eligibility.** Capture the remaining annual maximum, coverage tiers, frequency history, downgrade behavior, and missing tooth clause. See [Bill dental claims](/guides/billing/run-the-dental-billing-cycle).
2. **Present a written estimate with the treatment plan.** Show the expected plan payment, any projected downgrade difference, and the patient's estimated share for the specific case.
3. **Collect the estimated patient share at or before the visit.** The cheapest dollar you will ever collect is the one collected chairside.
4. **For major cases, use a predetermination to inform the estimate.** See [Get predeterminations](/guides/billing/get-predeterminations).

A patient who signed an estimate showing "your plan pays this filling at the amalgam rate; the difference is yours" pays the statement. A patient who first learns of the downgrade from the statement disputes it. **Surprise is the real collection problem; the statement is just where it surfaces.**

## Statement cadence

<Steps>
  <Step title="Send within days of adjudication, not at month-end">
    Batching statements to the first of the month means a patient seen on the 3rd gets a bill in the following month, six or more weeks after the visit. By then they have forgotten the appointment and treat the bill as an error. **Statement timing moves collection rates more than statement wording.**
  </Step>

  <Step title="Second statement at ~30 days">
    With a clearer call to action and the payment link prominent.
  </Step>

  <Step title="Contact at ~45–60 days">
    Call or text the patient and offer a payment plan where appropriate. For a balance caused by an exhausted maximum, explain that the plan reached its yearly cap and show how that changed the patient's share.
  </Step>

  <Step title="Final notice at ~75–90 days">
    Stating plainly what happens next.
  </Step>

  <Step title="Decision at ~90–120 days">
    Collections, write-off, or continued internal follow-up. See [Use collections agencies (carefully)](/guides/billing/handle-collections).
  </Step>
</Steps>

## Make the statement explain itself

When benefit design creates a patient balance, state the specific reason: coinsurance, deductible, downgrade difference, frequency limit, or exhausted maximum. This requires [separate adjustment codes](/guides/billing/post-payments-from-835s). "Amount over your plan's annual maximum" is more useful to a patient than a generic "insurance adjustment."

## Delivery: digital first

| Channel                     | Cost per statement                      | Response |
| --------------------------- | --------------------------------------- | -------- |
| **Text with payment link**  | Very low                                | Highest  |
| **Email with payment link** | Very low                                | High     |
| Paper                       | Meaningful, including postage and labor | Lowest   |

Digital delivery with a **one-tap payment link** materially outperforms paper. Collect mobile numbers and email addresses at registration and get consent for electronic communication.

Keep a paper option for patients who need it, and comply with any state requirements on billing notice format.

## Make paying trivial

Every additional step loses payers:

* **A link that goes directly to the balance**, not to a portal login
* **No account creation required** to pay
* **Mobile-optimized**, because most people will open it on a phone
* **Multiple methods**, including card, ACH, and digital wallet
* **Payment plans self-service**, with defined terms
* **The practice name on the statement and the card descriptor** matching what the patient recognizes

**Descriptor mismatch is a leading cause of healthcare chargebacks**, and it is worse in a DSO structure where the legal entity name differs from the practice brand by design. Configure the card descriptor to the brand the patient saw on the door, not the PC's legal name. See [Prevent chargebacks](/guides/payments/prevent-chargebacks).

## Payment plans

Define the terms in advance so staff aren't negotiating case-by-case:

| Element                    | Typical                                                       |
| -------------------------- | ------------------------------------------------------------- |
| Minimum balance to qualify | $200–$500                                                     |
| Maximum term               | 6–12 months                                                   |
| Minimum monthly payment    | $25–$50                                                       |
| Autopay required?          | Often yes because it improves completion                      |
| Interest                   | Generally none; charging it raises consumer lending questions |
| Default handling           | Defined in advance                                            |

Autopay under a signed card-on-file authorization can improve payment-plan completion. For large elective cases such as implants, full-arch treatment, or adult orthodontics, third-party patient financing may be preferable to a long in-house plan. If you offer it, keep the practice out of the credit decision.

Orthodontic contracts are their own animal: a down payment plus monthly payments across the treatment period, managed as a contract in the PMS rather than as statement-cycle balances. See [Orthodontics](/concepts/specialties/orthodontics).

## Membership plan billing is not statement billing

If you run an in-house membership plan, manage recurring card billing, expired-card retries, and churn through the membership platform rather than the statement cycle. Keep membership fees separate from patient accounts receivable on the ledger. A member's discounted treatment balance still follows the normal estimate and statement process. See [Launch a membership plan](/guides/payments/launch-a-membership-plan) and [Membership and discount plans](/concepts/payments/membership-and-discount-plans).

## Financial policy

Have patients sign one at registration. It should cover:

* When payment is due, and that estimated patient shares are collected at time of service
* That insurance estimates may change after the plan applies downgrades, frequency limits, and annual maximums
* Accepted methods and card-on-file authorization
* Payment plan availability and terms
* No-show and late-cancellation fees
* What happens to aged balances
* Financial hardship and charity care, if offered
* Self-pay pricing and good faith estimates

A signed financial policy is also your best evidence in a chargeback representment.

## Good faith estimates

The **No Surprises Act** requires a good faith estimate of expected charges for **uninsured and self-pay patients** who schedule a service or request an estimate.<sup>2</sup>

This applies **whether or not you contract with payers**. Build the good-faith estimate workflow into scheduling because a scheduled service or patient request, rather than a claim, triggers it. See [The No Surprises Act](/concepts/compliance/no-surprises-act).

## DSO notes

**Patient payments are the PC's revenue** and land in the PC's account, like payer money. See [Structure accounts across your entities](/guides/banking/structure-accounts-across-entities).

The dental support organization may operate statement workflows through its staff and systems, depending on the state and agreement stack. The professional entity should retain any approval authority required by state law over financial policies that affect the patient relationship or access to care.

## Verify it worked

* [ ] Written estimates presented with the treatment plan, modeling downgrades and remaining maximums
* [ ] Estimated patient share collected at or before the visit
* [ ] Statements go out within days of adjudication
* [ ] Statements name the mechanism behind the balance
* [ ] Digital delivery with a direct payment link is the default
* [ ] No account creation required to pay
* [ ] Card descriptor matches the practice brand
* [ ] Payment plan terms defined, with autopay
* [ ] Membership billing kept separate from patient AR
* [ ] Financial policy signed at registration
* [ ] Good faith estimates issued to self-pay and uninsured patients at scheduling
* [ ] Patient payments landing in the **PC's** account

## Common failure modes

| Failure                                                            | Consequence                                                 |
| ------------------------------------------------------------------ | ----------------------------------------------------------- |
| Estimating from the insurance card instead of verified plan design | Surprise downgrade and maximum balances on every major case |
| No collection at time of service                                   | The cheapest dollar becomes the hardest                     |
| Month-end statement batching                                       | Bills arrive six weeks late; treated as errors              |
| Statements that don't explain the balance                          | Phone calls, disputes, chargebacks                          |
| Paper-only delivery                                                | Low response, high cost                                     |
| Payment requires portal registration                               | Large drop-off                                              |
| Descriptor doesn't match the brand                                 | Chargebacks                                                 |
| Payment plans without autopay                                      | Low completion                                              |
| Membership fees mixed into patient AR                              | Both numbers wrong                                          |
| No GFE for self-pay                                                | No Surprises Act non-compliance                             |

## Sources

1. NADP enrollment and plan-design reporting via [GlobeNewswire (May 2026)](https://www.globenewswire.com/news-release/2026/05/18/3296940/0/en/NADP-provider-patient-benefits-rose-dental-plan-enrollment-fell-in-2024.html); Delta Dental, [What is a dental insurance annual maximum?](https://www.deltadental.com/protect-my-smile/dental-insurance-101/what-is-dental-insurance-annual-maximum/). Typical maximums $1,000–$2,000
2. No Surprises Act, Consolidated Appropriations Act, 2021, Pub. L. 116-260, div. BB, tit. I. CMS, [No Surprises Act](https://www.cms.gov/nosurprises).