Should Dental Practices Add a Credit Card Surcharge?

Note: Surcharging rules vary by state and may change over time. This article is for general discussion only and is not legal advice. Practices should consult their attorney, processor, and applicable state requirements before making changes to payment policies. 

Three percent sounds small until you see what it can mean across a dental practice’s annual collections. That tension drove the latest episode of Dinosaurs vs. Disruptors, where Dr. Ryan Hungate, Chief Clinical and Strategy Officer at Henry Schein One, and Barbi Elmore, Senior Director, Product Management for Revenue Cycle Management at Henry Schein One, debated whether dental practices should pass credit card processing fees on to patients or absorb them as a cost of doing business. 

Ryan took the disruptor side: if a practice is paying 3% in processing fees, surcharging may be a straightforward way to protect margin. Barbi, forced into the dinosaur seat by the coin toss, argued the patient experience side: if patients are surprised by an added fee at checkout, the practice may win a line item and lose trust. 

Then Jill Nesbitt, CEO of Optimize Dental Consulting, joined the conversation and brought the episode back to the reality of dental operations: surcharging is not simply a financial decision. 

Top Three Takeaways 

1. Surcharging is not just a finance decision. It affects patient trust, billing workflows, front desk communication, and compliance. 
2. Practice readiness matters. If estimates, collections, and patient communication are already messy, adding a surcharge can make the experience worse. 
3. Integration is a major factor. Payment processing that does not connect cleanly to the practice management system (PMS) can create manual work, reconciliation issues, and operational risk. 

The financial math is real, but so is the patient experience risk 

Ryan’s argument started with the math. A 3% credit-card processing fee on a $2 million practice can represent roughly $60,000 a year in margin leaving the business. For multi-location groups, that number can grow quickly. 

“If you’re looking at your practice and you’re trying to change nothing and make more money, I think surcharging’s it,” Ryan said. Later, he framed the core tension even more directly: “The fear is anecdotal, and the math is real.” 

Barbi pushed back from the patient perspective, asking, “Is it a quick way to also lose some of the trust of your patients?” Her point was that a surprise fee at checkout can feel very different to a patient already navigating treatment costs, financing, and insurance limits. 

Surcharging depends heavily on payor mix and practice model 

Jill’s first major point was that surcharging doesn’t make equal sense for every practice.  

“If you are a 100% fee-for-service practice, I’d say I would never bother with this ever. If you need to make a little more money and you need a little bit more revenue, then adjust your fees.” 

But for PPO-heavy practices and DSOs, the calculation can look different. If most of the fee schedule is constrained by insurance reimbursement, practices may not have the same ability to raise prices to offset processing costs. In that environment, surcharging becomes a margin pressure tactic worth considering, but only if the rest of the operation is ready. 

Practices should fix billing and estimate problems before adding another fee 

The clearest warning in the episode came from Jill: if a practice is already struggling with patient billing, insurance estimates, or collection conversations, surcharging can add fuel to the fire. 

She described a five-location group that had recently gone through a software conversion and was struggling to produce accurate insurance estimates. Patients were so frustrated with the office that they were leaving negative Google reviews about billing. 

“Don’t even think about surcharging if you’re not confident and have a good patient experience simply on getting an accurate insurance estimate and collecting the right copay,” said Jill. 

Barbi agreed and connected it back to the realities of revenue cycle management (RCM). “Why would somebody be okay with you putting 3% on top of a number that you’re not even confident about?” 

Payment technology integration may matter as much as the fee itself 

One of the most practical parts of the episode centered around what happens operationally when payment processing doesn't integrate with the PMS. 

Jill shared a story about a multi-location dental group whose private equity partner selected a medical merchant service based largely on the financial deal. The problem: it didn’t integrate with their PMS. The result was no text-to-pay, recurring payments, or swipe-and-post workflows, and an increase in manual reconciliation. 

“It is not just about the money and the deal that you can make,” said Jill. “Workflow and PMS integration is a major, major factor.” 

Ryan made the same point from another angle: “If you’re choosing anything out there that’s not deeply integrated, and you’re not accounting for this correctly, it’s buyer beware.” 

The front desk needs support before patients ever see the change 

Even when surcharging is an executive-level decision, the conversation often lands at the front desk, making change management essential. Teams need to understand why the change is happening, how it affects patients, what language to use, and when to escalate concerns. 

As Barbi put it: “The executives need to make sure that those people on the front line are supported with the right talk tracks.” 

Jill recommended that leaders explain the margin pressure, prepare the team for likely questions, and create clear steps for handling upset patients before the policy appears on the payment terminal or patient statement. 

Compliance and flexibility are non-negotiable 

The group repeatedly emphasized that surcharging rules vary by state and jurisdiction. Some states restrict or prohibit certain approaches, and rules can change. That makes flexibility in systems, receipts, workflows, and configuration essential. 

“We are not a legal firm. Do not take this as legal advice,” Barbi said during the episode. Her product-side takeaway was that payment tools should support the decisions a practice makes after doing its own compliance work. “We want you to be able to set it up in a compliant way, super easy, and to be able to have that transparency.” 

The real takeaway: surcharging is one piece of a bigger payment strategy 

By the end of the episode, even the debate format softened into a more practical conclusion: the right answer depends on the practice. Surcharging may make sense for some practices under margin pressure, especially those with strong billing workflows, clear communication, integrated payment technology, and the ability to configure policies correctly. It may be the wrong move for practices already struggling with patient complaints, inaccurate estimates, weak collections processes, or a fragile front-desk experience. 

Barbi summed it up well: “Surcharging is just one piece of a bigger picture. You really need to understand how you are rolling out your financial platforms, how you are rolling this out to your patients, how you are communicating.” 

Before adding a surcharge, ask these questions 

• What percentage of the practice is fee-for-service versus PPO? 
• Are insurance estimates accurate enough that patients trust the final balance? 
• Does the front desk have clear language for explaining the policy? 
• Does the payment processor integrate with the PMS? 
• Can the practice account for surcharges clearly and consistently? 
• Are text-to-pay, recurring payments, and saved-card workflows supported? 
• Has the practice confirmed applicable state and processor rules? 
• How will patient complaints, reviews, and disputes be monitored after rollout? 

Final takeaway: don’t treat surcharging like a quick switch 

Surcharging may look simple from the outside: add a percentage, disclose it, and move on. But the episode makes clear that successful implementation depends on the bigger revenue cycle ecosystem. Practices need reliable estimates, confident collections conversations, trained team members, compliant configuration, and integrated payment workflows. 

In other words, the question your practice needs to ask is whether it’s operationally ready to surcharge without damaging patient trust. 

Listen to the full episode of Dinosaurs vs. Disruptors wherever you get your podcasts. 

FAQ: Dental Practice Surcharging and Payment Processing 

What is dental practice surcharging? 

Dental practice surcharging is when a practice adds a fee to a credit card transaction to help offset payment processing costs. Rules vary by state and payment network, so practices should verify requirements before implementing any surcharge policy. 

Should dental practices pass credit card fees to patients? 

It depends on the practice’s payor mix, patient communication strategy, billing accuracy, compliance requirements, and payment workflow. PPO-heavy practices may feel more margin pressure, while fee-for-service practices may have more flexibility to adjust fees instead. 

What should a dental practice fix before considering surcharging? 

Practices should make sure insurance estimates, copay collection, billing communication, and front-desk workflows are already working well. If patients are already frustrated by inaccurate balances or unclear financial conversations, adding a surcharge may increase complaints. 

Why does payment processing integration matter? 

Integrated payment processing can reduce manual posting, support text-to-pay and recurring payments, improve reconciliation, and help teams account for fees more clearly. Without integration, practices may create extra work for the front desk and increase the risk of errors. 

How can practices protect patient trust if they surcharge? 

Practices should communicate clearly before checkout, train the front desk with consistent language, offer alternative payment options where appropriate, and make sure patients are not surprised by the fee. Transparency and timing matter as much as the policy itself.