Text messaging or SMS communication is a great way to reach patients if you want your bill to be seen and dealt with quickly. According to a study by Qualtrics and Accel, young millennials check their phones on average 150 times a day. An eMarketer study conducted in 2016 also revealed that the average adult spends more than 4 hours per day on their mobile phones.

Text reminders can be effective in a way that paper statements and phone calls are not. Texting is part of many patients’ normal daily routine and it’s convenient for patients. Texts are also seen as less intrusive by patients than a follow-up call.

There are a variety of approaches that providers can use when text billing patients. For example, providers can send text alerts to remind patients of statement availability or when payment is about to be deducted for recurring payments. It could also be in the form of a text message, notifying patients that payment is due, with a link that they can click which takes them to a patient portal where they can pay immediately.

In a way, text messaging drives the adoption of online payments because the process is so simple. Your patients pay online and you are able to collect quickly at a low cost to your business.  One survey revealed that 65% of consumers (respondents) pay their bill on first text notification.

Text billing can lead to quicker payment and improved collection efficiencies but it is not without costly compliance risks. It’s important that you understand the rules and regulations around using text as a collection tool.

In 2017, Uber agreed to pay $20 million to settle a class-action lawsuit over allegations it sent unsolicited text messages in violation of TCPA. Prior consent is not the only hurdle you’ll have to go through when text messaging consumers. There are other things to watch out for.

In September 2013, the Federal Trade Commission fined a debt collector $1 million for FDCPA violations involving text messaging, but not directly because of the text messages but for failing to identify themselves as debt collectors.

Relevant Laws

There are different laws that may apply when you use text billing into your collection strategy. Some apply to the communication method, some to the industry itself and some may apply depending upon the information being sent.

  • TCPA: The Telephone Consumer Protection Act (TCPA) was enacted in 1991 to protect consumers from unsolicited automated calls, texts, and faxes. TCPA violations cost at least $500 per illegal call, text, or fax. This can add up quickly when you text thousands of individuals at a time.

Because a text is considered a call, TCPA applies. If you will be sending mass texts, you must keep TCPA in mind. Calls (or texts) to cellphones using any form of artificial or prerecorded voice or using an automated telephone dialing system (ATDS) without the recipient’s consent is illegal. While the law does allow for some exceptions, they are quite narrow.

  • FDCPA: The Fair Debt Collection Practices Act applies due to communication with consumers about their debts.
  • HIPAA: When collecting medical debt, HIPAA (Health Insurance Portability and Accountability Act) is an additional concern that should be addressed when considering any communication with consumers.

In addition, though not federal law, there are messaging best practices and guidelines set by the CTIA (Cellular Telecommunications and Internet Association) which represents the U.S. wireless communications industry and is comprised of representatives from major telecom companies, such as carriers and suppliers.

Here are things to remember when texting billing patients:


  1. Ask for consent for all communications

It is good practice to adopt documentation policies that clearly confirm a patient’s consent to use their number for billing and collection purposes.

It is best to gain consent to text while speaking live with the consumer on the phone. During this process, debt collectors can verify the mobile number and send an opt-in text while still speaking to the consumer, ensuring the process is complete before concluding the conversation. Consent can also be gained through your facility’s website, allowing consumers to feel more in control of their preferences.

You can also get consent through a well-written consent form as part of new patient paperwork, or to existing patients at their next visit.

Providers can’t just get the patient’s consent to send one sort of message, but then send something totally different. Patients need to consent or opt-in, very specifically, to the specific type of messages that you’ll be sending them.

  1. Use secure messaging platform or encryption

HIPAA requires providers to use security measures when communicating with patients via text/email, such as encryption or secure messaging platforms. Alternatively, providers need to obtain consent from patients to send protected information via unsecured email or text. Sending protected information over unsecured emails or texts without a patient’s consent can violate HIPAA. Also, remember that “password-protected” is not the same as “secure” or “encrypted.”

  1. Include an opt-out message in all texts

Opting out or revocation should be offered at any reasonable time, place or manner for those wishing to discontinue communication by text. Your center must also immediately take action to stop texting them as soon as reasonably possible.

  1. Include certain disclosures as required by regulation

For example, text messages must include certain disclosures as required by CTIA. FDCPA also requires debt collectors to inform the consumer of the following (mini-Miranda):

  • The contact is from a debt collector
  • The purpose of the communication is to collect a debt
  • Any information disclosed by the consumer will be used to collect the debt

Your text message would essentially contain:

  • Name of your company
  • Mini-Miranda
  • “Text rates may apply”
  • Opt-out (can use shortcode)
  • Additional shortcodes if action is needed


  1. Don’t combine marketing, healthcare information, or billing info in a text

You need consent if there’s any type of marketing in a message (despite the presence of health info). Consent can’t be mixed either. Consent to receive medical bills on your cellphone is not the same as consent to receive text messages that contain marketing.

  1. Don’t include a patient’s PHI (protected health information)

Unless a provider or practice has a secure text messaging platform, text messages are not secure or encrypted. Text messages are easily intercepted, often sent to an incorrect number, and usually stored indefinitely on third-party devices, such as the wireless carrier’s servers. Thus, text messages should not include a patient’s PHI.

  1. Don’t send patients text bills without helpful agents

      Texting without having trained personnel readily available to take questions or comments from patients would be counterproductive. In healthcare, just sending patients text bills without helpful agents actually causes more complaints than payments!

      According to InstaMed’s Trends in Healthcare Payments Eighth Annual Report: 2017, consumers are quite confused:

      • 72% are confused by their explanation of benefits.
      • 70% are confused by medical bills.

      When making a significant decision, most consumers want to talk to a qualified human expert. According to a study by Google, 61% of mobile users call a business when they’re in the purchase phase of the buying cycle. This is because consumers are looking to get a quick answer (59%) or want to talk to a real person (57%).

      Turnkey Solution: Partner with A Licensed Patient Financial Services Company

      When adopting a text billing solution, it is critical that you have a highly compliant and sophisticated revenue cycle management strategy. Text billing works best when complemented with helpful agents from getting consent (ensuring that the consent process is complete) up to answering questions about the bill. Highly skilled agents who are good at speaking with patients can more than pay for themselves.

      Hence, the best strategy is to partner with a licensed Patient Financial Services company that offers a complete text billing solution and patient call center all-in-one.

      Make sure that you partner with a company that has well-trained agents who can answer insurance coverage questions, offer financing solutions, and have a firm understanding of TCPA, FDCPA, and other relevant collection laws.

      About Mnet, Health-Mnet Heath is a licensed, financial services company that offers healthcare providers a way to give their patients a first-class and highly supportive financial experience. Mnet’s Paysuite technology includes a HIPPA compliant text billing solution. To learn more or receive a demo call (866)648-4677.