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Write-offs at the dental office: do’s and don’ts of writing off payments

April 30th, 2024 | 10 min. read

Write-offs at the dental office: do’s and don’ts of writing off payments Blog Feature

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You know that feeling when you take an IOU from someone, but then they never pay you back?  That’s what a write-off in a dental office is like — you delivered, yet there’s no return.

A write-off is a way to track lost income. It represents the amount you will not collect for the work you and your team produced. It can happen with any expected payment: insurance claim reimbursement, patient payments, and even payments from family and friends. 

If you want a healthy dental practice with consistent cash flow, you’ll want to minimize write-offs. In this article, our revenue cycle management (RCM) experts have shared 19 practical, proven tips for how to do that. 

You’re running a business, so of course there are going to be write-offs — but there can be fewer than you’d think. 

Let’s talk about it… 

Write-offs from denied dental insurance claims: Do’s and Don’ts

Let’s start with the big one: insurance claims write-offs

We aren’t talking about Preferred Provider Organization (PPO) write-offs here. Sure, you will have contractual write-offs if you charge standard office fees to a patient, yet participate with their insurance. 

That’s just part of shaking hands with an insurance company, and the patient deserves that in-network discount. What we are discussing here is writing off amounts you’re owed because insurance wouldn’t pay. DCS-dentalwriteoffs-optionG

We know what you’re thinking: “Sometimes insurance just won’t budge! I can’t spend hours on hold with an insurance company!” And we get it.

Dealing with insurance is a pain, but it pays off in real money. When your insurance claims are denied, or appeals aren’t going through, it can be tempting to write those off.

But here’s what you should do instead to put the money you’ve earned in your bank instead of leaving it in theirs…


  1. Commit to appealing your claim at least twice. That can sound like a heap of hurdles to climb over, but it will be worth it when you collect the payment on the other side.
  2. Provide as much information as possible with every claim. It’s common for claims to be denied due to “lack of evidence” — missing attachments such as x-rays, intraoral photos, narratives. Make sure you’re including all of this information in your appeal, and also in future first-time claim filings to avoid denials altogether.
  3. Have someone take the time to talk with insurance companies. A common reason dental teams give up on unpaid claims is they don’t have time to sit on the phone with payers — they truly could be on hold for up to an hour, sometimes more. In an ideal world, someone is fully dedicated to getting all your claims paid, whether that’s a person on your in-house dental team or your RCM service provider.


  1. Do not let insurance companies dictate your dentistry. Even if you have to talk to multiple people at an insurance company, do not take no for an answer. If the patient’s benefits are active and verified, and you have provided all necessary information to the payer, you should be paid.
  2. Do not let insurance claim denials be your last chance for payment. Insurance companies work hard to avoid paying you, so you need to work equally hard to submit error-free claims. But if your patient understands they will need to pay whatever amount their insurance does not, then you will be paid at some point, one way or another. 
  3. Don’t give up! You’re not being annoying when you call the insurance company to track down a payment — and it’s still worth doing even if you were. Trust me, insurance companies have enough money. Get what you’re owed.

Insurance claims management is a challenge for everyone because payers create the rules and change them often. But if you follow their rules and guidelines, and also follow up continually and consistently, then you’ll keep control of your cash flow.

It’s crucial that your office has a person dedicated to working your insurance aging report regularly — and also that the person has the tools, skills, and experience necessary to win the ongoing fight for unpaid claims. 

Write-offs from unpaid dental patient balances: Do’s and Don’ts

Collecting overdue patient payments is trickier than collecting from insurance. You’re dealing with real people, and their hard-earned money — and going to the dentist isn’t cheap. You don’t want to irritate or pester your patients, but you also need to be paid for services rendered.    

Related: 3 ways patient billing mistakes harm your dental business

Ideally, every patient pays before they leave your dental office, immediately after their treatment.

However, some offices struggle with collecting from patients on the day, then don’t want to bother the patient by repeatedly contacting them about their overdue payment. Eventually, those payments are written off, but here’s what you can do instead:


  1. Be sure your patient understands their responsibilities. Before their treatment, explain that they will be responsible for any treatment costs not paid by their insurance.
  2. Be kind and understanding. If they’re put on the defensive when you call a patient about a late payment on a dental bill, they’re less likely to pay it. They also won’t pay a bill they don’t understand, so make sure you offer a logical explanation for the amount owed, including how much their insurance covers.Dental patient in the chair after they've already paid for treatment, helping reduce write-offs for the dentist.
  3. Apologize for mistakes. If the patient is being billed because their calculated out-of-pocket cost was inaccurate, explain your office’s mistake and accept responsibility for it. Taking ownership of this mistake can go a long way toward maintaining a positive patient relationship.
  4. Offer a payment plan. The cost of quality dental care can be too much for some to handle in a single payment. Offering a plan for paying in installments is a compassionate way to get a patient to pay what they owe. It may take 3 to 6 months to collect in full, but it’s better than not being paid at all.
  5. Educate your dental patient on their insurance policy. Most dental patients do not understand their insurance benefits and which procedures are or aren’t covered.  This is why treatment presentations are valuable, where you explain costs before their procedure. Patients are more likely to pay you promptly if they know in advance why they owe what they owe. 


  1. Do not mail a bill without following up. Paper bills get lost in the mail more often than you think, and even emails might not make it to their inbox. If a week goes by, and the bill hasn’t been paid, follow up with a phone call to make sure they received it.
  2. Do not call a patient empty-handed. Follow up on patient payments the same way you would with insurance claims: with all the treatment, insurance, and billing information in hand, so you can explain to your patient why they owe what they owe. If your team doesn’t have time for this, you can automate your entire patient payment follow-up process. 
  3. Do not let it go just because it feels awkward. Money can be hard to talk about, and even harder to ask for, but your dental business needs to collect payments from its patients to stay afloat. It’s perfectly reasonable to call a patient about an unpaid bill. Some people will be glad of the reminder, and some won’t, but they’re all getting the signal that your office expects to be paid for services. 
  4. Do not go it alone if you need backup. If the claim was accurate, yet insurance still resists paying, you may need to get the patient involved with their insurance provider to help resolve it.

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Don’t write off a claim without trying to get the balance paid by the patient. No one is happy to receive an unexpected bill, but if you clearly communicated to the patient that they’ll be responsible for the expenses insurance won’t pay and why their insurance won’t pay it, they will understand.

Related: Happy patients, happy practice: 3 ways to improve your dental patient experience

Write-offs from special patients (friends, family, and staff): Do’s and Don’ts

You thought dealing with patient payments was sticky? Just wait until you’re calling about a payment from someone you know personally — or are related to. 

Dental practices are commonly run by families or spouses, and it’s not uncommon for the dentist to offer free or discounted services to family members and friends. But providing treatment isn’t free — the services, medication, staff time, and equipment used all cost money. Dentist treating a family friend who has paid for their treatment.

It’s up to the dentist, business owner, or office manager to set boundaries and document rules about friend and family discounts. These should include: who will receive discounts, who won’t, and how much the discounts are. These policies must be communicated clearly with the entire team and new hires.


  1. Give your family and close friends discounts on your services, unless… It’s generous to reduce prices for family and friends to have their teeth cleaned, especially if they don’t have insurance benefits to help lower out-of-pocket costs. But if you are not the dentist or business owner, the services aren’t yours to give away. Make sure you’re clear on your office’s friend-and-family policies. When in doubt, ask — don’t assume.
  2. Properly document any discount given to a patient if dental insurance covers them. If the patient has insurance, you will still need to file an insurance claim with the details of the discount included. The claim form should reflect the actual amount charged, noting any discount given. The insurance will then also pay less on the claim. If you misrepresent the actual fee charged, it will be considered overbilling, which could lead to your practice being guilty of fraud.


  1. Do not advertise among your friends that you offer free dental services. The more this becomes public knowledge in your circle, the more people will come to you asking for free or discounted dental services. Then, you’ll have to suffer the awkwardness of telling them no. 
  2. Do not be afraid to set clear boundaries among not just your friends, but also your staff. If a team member asks if their friend can receive discounted or free dental services, it’s okay to say no. Even if they’re a family member who works in your office who might expect a favor, refer them to the practice-wide rules for friend and family discounts.

It’s your dental business, and while it’s kind to offer free and discounted services to people close to you, it’s not something you can offer everyone, every time. Sometimes, you’ll have to collect the full price for services rendered, and it’s okay to explain this to people you know personally. 

Who is your designated expert to reduce write-offs?

Write-offs at the dental office boil down to lost revenue. Sure, sometimes it’s because you’re doing favors for friends and family, but sometimes it’s because insurance and patients refuse to pay. 

But if you follow our RCM experts’ 19 tips for how you should and should not handle writing off payments at your dental practice, you’re sure to collect more revenue

And if appealing insurance claims and chasing down patients for their payments would overwhelm your already busy office team, our billing experts would love to help out. 

DCS insurance billing and patient billing services are valued resources for teams who struggle with collections.

When you combine our billing experts’ knowledge with automated technology, both your insurance and patient billing processes will be seamless and consistently managed — resulting in fewer write-offs for you without extra work for your team. 

“Thank you to DCS for giving us the ability to stop stressing over submitting claims, and even more importantly, fighting unpaid claims which we all know can be very time-consuming. Our front desk has been able to focus more on our patients, checking eligibility as well as scheduling unscheduled treatment. All in all, we are very pleased with DCS, thanks again and keep up the great work!” — Google Review

Reduce your write-offs: Book a free 30-minute consultation with DCS today.

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