The Billing Emails Nobody Wants to Send: How to Collect What You're Owed Without Losing Patients
Your collection rate is 91% when the benchmark is 98%. That 7-point gap represents real money — and the reason it exists is that nobody on your team wants to be the person chasing patients for payment.
Priya Sharma
Healthcare Operations Specialist
The billing coordinator at a family dental practice once told me something that perfectly captures the collections dilemma in healthcare: “I know Mrs. Chen owes us $1,200. She’s been a patient for twelve years. Her kids come here. I see her at the grocery store. I’m not going to send her a collections letter.”
So she did not. And Mrs. Chen’s balance sat on the aging report for fourteen months until the practice eventually wrote it off. Multiply that by the thirty or forty patients in similar situations, and you start to understand why the average practice collects 91% when the benchmark is 98%.
The gap is not about systems. Every practice management system can generate statements. The gap is about discomfort — the deeply human reluctance to chase people you know and care about for money they owe.
$70,000-$90,000
per year
Revenue lost at a practice producing $1M annually with a 91% collection rate versus the 98% benchmark — the financial cost of the collection comfort gap
Patient Billing Follow-Up Automation
The Comfort Gap in Collections
Average collection rate: 91% — benchmark target is 98-99%
Dental practice management benchmarks
Average days in accounts receivable: 40-50 days — target is under 30
Healthcare revenue cycle data
Payments received 16 days faster with automated billing follow-up
Pearly dental A/R research
30-40% improvement in collection rates with systematic billing automation
Pearly dental A/R research
Healthcare billing has an emotional dimension that billing in most other industries does not. When a plumber sends a collection notice, the customer does not feel betrayed. When a dental practice sends one, the patient may feel that the relationship they valued — the one where Dr. Reyes asked about their kids and remembered their vacation plans — was actually just a transaction.
This emotional risk is real, and it affects both sides. Staff avoid sending aggressive collection communications because they do not want to damage the patient relationship. Patients avoid paying outstanding balances because the bill reminds them of an experience they may not have enjoyed (especially if it involved pain or unexpected costs).
The result is a standoff. The practice does not push. The patient does not pay. The balance ages. The write-off eventually happens. And both sides lose.
Why Automation Fixes the Comfort Gap
Automated billing follow-up solves the emotional problem by removing the personal dimension. When a patient receives an automated statement at regular intervals — friendly, professional, consistent — it does not feel like the billing coordinator is singling them out. It feels like a system. Because it is.
This is not a subtle distinction. A phone call from someone they know saying “you still owe us $1,200” feels confrontational. An automated text saying “Your statement balance of $1,200 is due. Pay online here: [link]. Questions? Reply to this text.” feels routine.
The patient still has to pay. But the interaction is stripped of the interpersonal awkwardness that prevents staff from following up and patients from responding.
| Aspect | Manual Process | With Neudash |
|---|---|---|
| Statement delivery | Mailed paper statements — arrive in 3-5 days, often discarded with junk mail | Text and email with payment link — delivered instantly, opened within minutes |
| Follow-up timing | Inconsistent — depends on staff availability and willingness | Systematic: day 1, day 15, day 30, day 45, day 60 — same sequence for every patient |
| Payment options | Check or cash at the office, maybe a phone payment | Online payment link, payment plan setup, text-to-pay, credit card on file |
| Emotional burden | Staff feel uncomfortable chasing patients they know | System handles routine follow-up — staff only involved for exceptions |
| Aging report management | Reviewed sporadically, often monthly | Real-time tracking with alerts when accounts hit 30, 60, 90 day thresholds |
| Patient perception | Personal — feels like being singled out | Professional — feels like a standard business process |
The Billing Follow-Up Sequence
The most effective billing sequence I have implemented across medical and dental practices follows a five-touch escalation over 60 days. The tone starts friendly and gradually increases urgency — but never becomes threatening. The goal is to make paying easy, not to make not-paying scary.
Day 0 — Initial statement. Sent via text and email immediately after insurance payment is posted: “Hi [name], after your insurance payment was applied, your remaining balance is $[amount]. Pay online here: [link]. If you have questions about your balance, reply to this text.”
Day 15 — Gentle reminder. Text only: “Hi [name], just a reminder that your balance of $[amount] is outstanding. Pay conveniently online: [link].”
Day 30 — Payment options. Email with more detail: includes the original statement, a payment plan option for balances over $500, and a direct payment link. For smaller balances, this message often triggers payment because it makes paying trivially easy.
Day 45 — Urgency without threat. Text: “Hi [name], your balance of $[amount] is now 45 days past due. We’d like to help resolve this. If cost is a concern, we offer payment plans — reply to discuss options or pay here: [link].”
Day 60 — Personal outreach trigger. The system alerts the billing coordinator that this account needs a personal phone call. By this point, four automated messages have been sent. The 20-30% of patients who have not responded to any of them likely need a human conversation — about a payment plan, a financial hardship, a billing question, or a dispute.
Pro Tip
The single most impactful change you can make to your billing workflow is collecting a credit card on file at the first visit. Practices that keep a card on file can process patient-responsibility balances automatically after insurance pays — with the patient’s pre-authorization. This eliminates the entire follow-up sequence for most patients and reduces days in A/R from 40-50 to under 10 for patient balances. Communicate it as: “We keep a card on file to process your portion after insurance pays, so you don’t have to deal with statements. You’ll receive a receipt by email.” Most patients prefer this to receiving bills.
The Payment Plan Opportunity
One insight that repeatedly surprises practice owners: many patients who have not paid are not refusing to pay. They cannot pay the full amount at once. A patient who owes $1,800 after a crown prep may genuinely want to pay but cannot write a check for $1,800 this month.
Offering payment plans in every billing communication — not as a last resort, but as a standard option — dramatically increases collection rates on larger balances. “Pay $1,800 today or $300/month for 6 months” gives the patient a path forward that does not require them to call the office and ask (which most patients will avoid doing because it feels embarrassing).
Automated billing sequences should include payment plan options at the 30-day mark for any balance above a threshold (typically $500-$1,000). The offer should be concrete: “Would you prefer to pay your $1,800 balance in 6 monthly installments of $300? Reply YES to set up a payment plan, or pay in full here: [link].”
What the Data Shows
The practices I have helped implement automated billing follow-up consistently see three improvements:
Days in A/R drops from 40-50 to 25-30 — because patients pay faster when payment is made easy and reminders are consistent.
Collection rate improves from 91% to 95-97% — because the 30-40% of patients who would have been written off respond to systematic follow-up when the friction of paying is removed.
Staff time on billing follow-up drops by 60-70% — because the automated sequence handles the first four touches, and staff only spend time on the 20-30% of accounts that need personal attention.
Collecting Without Losing Patients
The question every practice owner asks is: “Won’t aggressive billing cost me patients?” The answer is nuanced.
Aggressive billing — threatening letters, collection agency warnings, harsh language — absolutely costs patients. Systematic billing — consistent, professional, gentle, with easy payment options — does not. In fact, patients generally prefer knowing where they stand over the ambiguity of an unpaid balance hanging over the relationship.
The practices with the best collection rates and the highest patient retention are not the ones who are aggressive about billing. They are the ones who are consistent. Every patient gets the same sequence. Every message is professional. Every communication includes an easy way to pay or set up a plan. Nobody is singled out, nobody is embarrassed, and nobody on the staff has to have an uncomfortable conversation — until the system has already tried four times and determined that a human touch is needed.
That is the balance: systematic enough to collect, human enough to retain.
Tools Referenced
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About Priya Sharma
Healthcare Operations Specialist
Health administration professional who has implemented workflow systems across 30+ medical and allied health practices. Passionate about reducing administrative burden so practitioners can focus on patients.