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Auto-Pay collects payments from patients who have a credit card on file and have agreed to be charged for their next balance. Instead of sending reminders and waiting for the patient to pay, Pearly sends a short series of notifications and then charges their stored credit card. You can configure the Auto-Pay outreach rules on the Auto-Pay → Automation page. Consent settings live under Account → Auto-Pay. If you don’t see Auto-Pay in your Pearly dashboard, contact support to have it enabled.

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Eligibility

A balance enters Auto-Pay only when all of the following are true:
  • The guarantor has a payment method on file.
  • The guarantor has given consent for Auto-Pay.
  • The balance meets your Auto-Pay start rules.
  • The patient portion is at or below the maximum amount on the guarantor’s consent.
Auto-Pay and billing outreach never run at the same time for the same guarantor.

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Patients get notified before they are charged

Every Auto-Pay flow begins with notifications. Pearly sends the start text and email you configured, then reminders on the days you set. Only after the last reminder and the final buffer does Pearly charge the stored payment method, for the full patient portion. Auto Pay Flow 1 Pearly doesn’t charge a patient whose notifications never reached them. If none of the messages were delivered or opened, the charge is skipped. Patients in Auto-Pay don’t receive letters. Auto-Pay groups balances into tabs:
  • Outstanding: the guarantor qualifies for Auto-Pay, but the balance doesn’t yet meet your start rules.
  • Scheduled: the balance meets your start rules and is queued to begin.
  • Engaged: a flow is in progress and notifications are being sent.
  • Ready to Charge: the notification phase is complete. Balances that couldn’t be charged automatically wait here for your review.
  • Failed Charge: a charge was attempted and declined. The patient will move into a standard Billing outreach flow 5 days after the failed charge.
Pearly never charges a patient automatically without consent. You can view proof of consent anytime for a patient under Profile > Payment Method > Charge Consent Authorization. There are three ways to collect Auto-Pay consent:
  • When they make a payment: the patient is asked to agree at checkout
  • In office: your staff can record consent on a patient’s behalf using a separate in-office agreement.
  • Financial policy: if your practice’s financial policy states that keeping a card on file authorizes automatic charges, you can enable financial policy consent and set its effective date. Any patient who adds a payment method on or after that date is treated as having consented.
Screenshot 2026 10 20 At 4 39 14 PM Each consent includes a maximum amount, taken from your account setting at the time the consent is given. A balance above the maximum isn’t eligible for Auto-Pay.

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How patients opt-out of Auto-Pay

If a patient revokes consent, any active Auto-Pay flow ends immediately, the patient won’t be charged automatically again. To rejoin Auto-Pay, they need to sign a new agreement.

Patients can Opt-Out in their billing portal anytime by going to Update Payment Method > Charge Consent Authorization > Remove Consent. Screenshot 2026 10 29 At 11 27 45 AM In the Pearly, you can Opt Out or view a proof of consent for a patient at anytime by going to their Profile > Payment Method > Charge Consent Authorization. You can view and customize the default Auto-Pay consent terms anytime under Account > Auto-Pay > Consent Terms. Please contact support to change the consent terms for all locations in your group.