Keeping Credit Cards On File Is The Only Option

Image: Swiping a credit cardIf you’ve read this blog long enough, and you’ve heard me speak at conferences, you know I’m a huge proponent of practices implementing a credit card on file policy.

If you don’t know what I’m talking about, I’m referring to the practice of asking patients to leave a credit card on file (with the practice) to cover balances that the health insurance companies deem patient responsibility.

Much like a car rental company or a hotel requires a credit card on file for incidental.

Our practice has been doing this since 2009 and we’ve never looked back. It has been one of the best decisions we’ve ever made. Not only was it not as difficult to implement as we thought, but we’ve been able to improve our accounts receivables.

As it turns out, I found a practice that has been doing the credit card on file thing  longer than we have. I wanted to learn more about their experience so I asked Melanie, the manager of this practice, if she could answer a few questions about their experience in implementing this policy.

She agreed. Enjoy!


 How long have you had the credit card policy in place? 

We have had this mandatory since 2008.

What do you use to store the cards and process the payments?

We’ve partnered with a vendor name Instamed that helps us with this process.

Do you give patients options or is the policy you have in your office rigid?

Our patients have the option of cc/hsa/debit card and also any copay amount they wish to leave in their credit account on the day of service or if they have coinsurance/deductible etc & don’t want the patient responsibility portion to go on their card.

What if a patient is completely against leaving the card on file?

If they are completely against the card on account, the only other option is to leave deposit of full network allowable at time of service & wait for me to refund by check any difference from what their insurance pays.

Do you have any patients that take this option?

We have maybe 2 that actually do this.

Are there exception to this policy?

This policy is across the board, even medicaid patients. We check daily for eligibility so no one with active medicaid is charged anyway.

Do you bend the rules for some patients?

You need to be consistent with your policy.

Surely there have been a few bends here and there?

For first time patients we do not bend. They are made aware by phone or mail of this [policy] before coming in. It’s also on our website under forms to bring to first visit as well. Some but extremely few have decided not to continue with the visit.

How about established patients, do you bend the rules for them?

For established patients we gave them a pass if they “didn’t bring one” for one visit & sometimes two, but if it went a third, I would go talk with them.

What would you tell them?

I explained it’s not personal, but necessary to keep consistent for all patients.

 If they don’t agree with the policy, then what?

Unfortunately, they would have to find another provider if they didn’t want to follow the policy.

 Your policy sounds fool proof, is it?

Keep in mind even having the card on account doesn’t guarantee that it will actually work by the time the era/eob comes back, though for the most part it does.

Eligibility I understand, but I think checking for benefits is a hassle. Do you check eligibility and benefits beforehand?

We are also on top of making sure we do our best to know everyone’s coverage, so patients are not surprised by what they may owe (front desk has a spreadsheet of payer allowable as only 20 fit in our EMR). This includes immunizations and we always let them know the health department is an option for those with coinsurance/deductibles. We are a vfc provider so medicaid or no-insurance is not a barrier.

Let’s say a practice is thinking about instituting this policy. What would be your advice to them?

Everyone needs to be on board and stand behind it. For established patients maybe you want to give them a pass on one visit but have them sign updated policy & let them know it’s required by next visit.

Anything else?

Be consistent with your policy.


I wish more docs would get over their fear of asking patients for a credit card company. It is the only way to shift the risk and responsibility back to the patient.

Just like patients are getting more savvy about the cost of healthcare and looking for ways to save, doctors also need to look at ways to operate with the understanding that financing patient’s medical services is not a very good long term strategy.

Reasonable patients will understand why you are doing it. Those that don’t understand ought to find another sucker then…

If you’ve implemented this policy, let me know. I’d love to hear about it.


  1. This is some of the worst advice you could possibly give a person. I went through 4 credit cards in 2012 and now 2 in 2013. The only “on file” merchants that had my number were Amazon, Apple and Walgreens. After a long discussion with my credit card company I learned all three had been hacked at one time or another in recent months. In the case of Walgreens, the hack was at a Walgreens service provider which also had my information.

    Never keep a credit card on file with anyone.