Dental credit cards, dental loans and other dental financing options let dentists avoid the risk of in-house dental financing.

But sometimes lenders don’t want to take the risk of either making it hard for many patients to get dental credit for dental care.

Read more: Dental Patients Can’t Get Credit: Dentist Survey

Most dentists these days don't offer their own dental financing, relying instead on dental credit cards and outside dental payment plans. "We’ve never offered inside financing," said one prosthodontist. "We don’t want to deal with any problems, so we farm the financing out."

“I wouldn't be able to sell all the cases without dental financing," said one dentist.

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Read more: Dental Financing: Outside Is Better Than Inside

His office has received complaints from hundreds of patients who were convinced by their doctor or dentist to sign up for a medical or dental credit card, only to find themselves beset by high interest rates and surcharges.

The Attorney General's office has issued subpoenas primarily to investigate GE Money's CareCredit card, but other subpoenas have also been issued for Chase Health Advance, Visa Health Benefits and Citibank Health Card.

Concerns have been raised that it is inappropriate for a dentist (or other medical practitioner) to simultaneously push for dental treatment and for dental financing.

Read more: NY AG investigating health care credit cards

On the other hand, 41% said they would if their bank would take an IOU, and 13% said they would only accept an IOU for a poor patient.

"I'd trust IOU's from my own patients who have fallen on tough times before I'd trust the government (at any level)," declared a Georgia orthodontist.

Here are some more comments:

• "The state won't take an IOU for my taxes!!!" (West Virginia dentist)
• "Patients who need state care are not responsible for the state's problems and should not be penalized." (Texas dentist)
• "Who could trust a state to cover past debts? What about if they legislate away past IOU debt, or if the state becomes insolvent and wipes out all debt?" (New Jersey dentist)
• "I would treat an indigent patient in pain for no fee. If my bank accepts the IOU and the money goes into my account, I am okay with it. If a state goes bankrupt, we are in deep doodoo." (California dentist)
• "What choice would you have? Take nothing? That's all you're going to get. At least it might get paid. Someday." (Texas orthodontist)

A Minnesota dentist described the flaws in that state's Care Tax:

"In Minnesota we have to pay a 2% provider (MN CareTax) on our revenue, which is a noble cause. Any donated care is taxed on the value of the care.

Note: … let's start letting the public and legislators know how much we donate care, so that they see we are more philanthropic than most other business owners!

This tax was supposed to go to help those without insurance or the means to pay. For the past many years, MN has seen this big fund as money they can confiscate to balance the General Fund, not to mention taking away the ability for many patients to use this fund.

In summary, I feel I already have accepted IOU's which will never come true. Lesson, never let your state tax providers for their services, it will end up being a money tree in the legislature's back yard to take for other reasons."

Read more: Dentists Dislike IOUs for Dental Financing

But a recent NPR report indicates that complaints about CareCredit have increased.

More patients are claiming they didn't realize they were signing up for payments they would never be able to afford.

"People are being convinced to take on more credit than they can afford," claims Elizabeth Landsberg, an attorney with the Western Center on Law and Poverty. "We have people who are living on a fixed income of $1,000 a month who are being signed up for $6,000 in credit. There's no way they can make those payments."

Though the American Dental Association endorses CareCredit, many people do not realize that the ADA is paid for its endorsement. "The blurring of medical provider and financial services provider is problematic," said Mark Rukavina from The Access Project, a health care advocacy group.

Read the NPR report

“Care Credit warned us that a lot more of our patients would not qualify," said one dentist, while another mentioned, “Enhance and Wells Fargo have discontinued dental lending."

Here's what else dentists have to say…

• “Do I offer patients options? Yes. They can go get some money.” (Tennessee dentist)
• “If the patient can’t get financed and has no credit card available, there is usually a good reason not to be that person’s bank.” (California dentist)
• "Most patients won't even fill out the application if they don't think they will be accepted. They usually know if they have bad credit.” (Kentucky dentist)
• “We use an outside third party company that will extract their payment from a checking account. They deal with any problems that arise like insufficient funds or closed accounts.” (Utah dental office worker)
• “As the economy worsens, we've discussed down payments of 1/3 and automatic credit card or secured/automatic debit from checking account. Patients don't always warm to Care Credit and their credit history being checked. Establishing the trust relationship is so important that often this aspect of care is the ‘make or break’ point.” (Maryland dental office worker)
• “We are still offering external financing to everyone, but the acceptance rate is getting lower and lower. So we start with emergency or needed treatment first and have firmer financing policies in effect.” (Utah dental office worker)

Read more: Patients Struggle for Credit Approval

The majority, however, haven't yet done so, and a few docs have even lowered fees.

“No one’s lowering my costs. So far my vendors, my labs, and my employees haven’t volunteered to lower their costs to me!” said a New York prosthodontist.

Dentists had a lot of opinions on the subject:

• “We have considered raising fees, but we are holding off for now. We were concerned we may discourage patients from proceeding with routine care and surgical therapy.” (California periodontist)”I have raised fees, but so far, it has not translated to the bottom line.” (Massachusetts dentist)
• “We may not raise fees unless supply costs continue to rise. Wages must also remain as is, or fees will have to rise.” (Wisconsin dentist)
• “The drop in the financial market has affected us. Gross is down 35%.” (New York dentist)
• “We raised our fees significantly and there has not been one complaint.” (Illinois dentist)
• “Elective procedures are down, and patients are deferring expensive dental implant restorations.” (New York oral surgeon)
• “We might increase cash discounts to encourage cash flow.” (Missouri dentist)

Read more: Changing Dental Fees in a Tough Economy

Very few dental practices these days offer their own financing. “We’ve never offered inside financing,” wrote one prosthodontist. “We don’t want to deal with any problems, so we farm the financing out.”

Here are some other things dentists had to say:

• “It is more difficult now for people to afford one more payment that they need to come up with the money for. In this economic climate, if it doesn’t hurt to offer financing if they want to wait.” (Pennsylvania dentist)
• “It really increases production and collections. Patients love the 0% financing.” (California dentist)
• “Outside financing has been a tremendous financial boon for our practice. Relationships stay where they should be when the payment is to a 3rd party.” (Illinois dentist)
• “We use Care Credit.” (California periodontist)
• “We’ve never offered inside financing. Everyone I’ve talked to says DON’T DO IT!” (Ohio prosthodontist)
• “We are surprised by the number of patients who are turned down by the outside agency. In most cases, we would have provided in-house arrangements.” (Ohio oral surgeon)

Read more: Dentists Prefer Outside Dental Financing,/p>