Dear Dangerously in Love with Finance,

I run a cash-based functional medicine practice in Austin and I’m losing my mind. We’re fully booked, patients love us, and I haven’t taken a day off in six months because I’m afraid of the revenue hit.

Here’s the problem: we collect credit cards at intake. Every patient has a card on file. But I’m sitting on $87,000 in unpaid balances.

We run the card after services and it declines. Or patients dispute the charge. Or the card expired. Or their HSA card only had $200 for a $3,500 program.

Then we’re chasing them with invoices and voicemails. “I’ll update my card next week.” “My HSA refills next month.” “I didn’t authorize that.”

I know I need a tougher payment policy, but how do I do it without losing patients?

Signed,
—Drowning in Austin

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Dear Drowning,

Let me hit you with some Texas-sized truth as a fractional CFO who works with functional medicine practices: having a credit card on file means nothing if you’re charging it at the wrong time.

And that $87K? Most of it’s already gone.

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The Card on File Illusion

Cards on file give you false security. You think you’re protected because “we have their payment info.”

But cards fail for a dozen reasons: insufficient funds, expired dates, cancelled and replaced numbers, fraud flags, HSA cards with no balance, chargebacks claiming unauthorized charges.

By the time you discover the problem, the patient already got the service. You ran their labs, spent hours in consultation, and created their protocol.

Now you’re chasing people who couldn’t pay upfront – and they definitely won’t pay after getting what they wanted.

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That $87K Doesn’t Exist

Let’s talk reality about aged receivables:

• Under 30 days old – you’ll collect maybe 85-90%
• 30-90 days – down to 70-75%
• 90-120 days – 50-60%
• Over 120 days – lucky to see 30%

If most of those balances have been sitting 60-90 days, you’re realistically collecting $45,000-55,000. That’s $32,000-42,000 that vanished.

And you’re still out the costs you already paid for labs, supplements, and staff time. Double hit.

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Why Your Revenue Doesn’t Match Your Reality

You provided $87K worth of services, but that money never hit your bank account. Since you’re using cash basis accounting, that $87K isn’t even showing up as revenue yet.

But here’s the killer – you’re still out the costs you already paid. You already paid out cash. The labs, the suppliers, the staff, the landlord—they all got theirs. You didn’t.

You paid out real cash to deliver those services but never collected the revenue. That’s why your checking account sits at $6,000 even though you’re working your tail off.

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What This Is Costing You

Carrying Costs: While waiting for patients to “update their card,” you’re paying 18-24% credit card interest to cover operating expenses.

Write-Offs: Eventually you’ll write off uncollected balances. After tax benefits, you still lose 65-70%. Plus you’re out the cost of labs and supplements already paid for.

Opportunity Cost: Every dollar stuck in receivables can’t be used to hire staff, invest in marketing, upgrade equipment, or pay yourself properly.

Blocked Growth: Banks look at your accounts receivable aging report and pass. No lender funds a practice where revenue is stuck in declined cards from six months ago.

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What Actually Works

Stop charging cards after services. Charge them before.

If someone can’t pay upfront, they won’t pay after getting what they wanted. Your $87K proves it.

Most functional medicine practices I work with resist this change because they’re worried about losing patients. But here’s what happens when you implement proper financial policies: the wrong patients leave (the ones who weren’t going to pay anyway), and the right patients – the ones who value your work – stay and refer others.

Payment options:

Financial conversation at intake. Before ordering labs. Before creating treatment plans. Verify the card works with a test charge. Lock in payment structure.

Set boundaries. If auto-payment declines, the patient doesn’t come in until it’s resolved. You’re not a bank. You’re a medical practice.

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The CFO Takeaway

You’re working 55-hour weeks and barely keeping your head above water. Not because cash-based functional medicine isn’t profitable – because you’re charging cards at the wrong time and eating the cost when they decline.

That $87K is costing you more than uncollected money. It’s costing you growth, stability, sleep, and the practice you envisioned.

This is exactly why functional medicine practices bring in fractional CFO services – not to manage your books, but to fix the financial infrastructure that’s bleeding cash. Someone who understands the unique challenges of cash-based functional medicine, has implemented these payment systems dozens of times, and knows how to protect your revenue without damaging patient relationships.

Get fractional CFO services that specialize in cash-based functional medicine practices. Implement real financial policies. Charge cards before services.

You deserve to be profitable AND liquid.

Lots of Love, Coffee and Chocolate,
Dangerously in Love with Finance

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Mindful Thoughts

Running a functional medicine practice means you’re committed to healing – but you can’t pour from an empty cup.

Financial stress isn’t just a business problem. It’s stealing your sleep, your time off, and your ability to show up fully for the patients who need you.

You didn’t build this practice to spend your energy chasing declined cards and unpaid bills. You built it to transform lives.

The right financial systems aren’t about reports or paperwork—they’re about boundaries that protect both your practice and your peace of mind. When your cash flow works, you stop losing sleep and start showing up the way your patients deserve.

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If you’re ready to stop working harder and start working with systems that actually support you, specialized fractional CFO services for functional medicine practices can help you build the financial foundation your practice deserves.

You deserve to be profitable, present, and at peace.

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This article is designed to provide information only and should not be considered legal or tax advice. Because of the complexity of the law and the variables in your own personal tax and accounting situation, you can’t rely on our advice specifically related to your unique circumstances. In order to get the best tax savings and legal advice available to you, you should consult with your own accountant, attorney or advisor regarding your particular facts and circumstances. Healthy Bodies of Finance is an accounting firm that specializes in working with health and wellness providers. We provide monthly accounting & bookkeeping services and financial education. For more information on our specialized services for health and wellness providers please contact us at info@healthybodiesoffinance.com