By Karen October 8, 2025
Healthcare, dental practices, and professional services businesses face unique challenges when it comes to payment processing. Unlike large retailers or ecommerce platforms that focus on high-value purchases, these industries often rely on a low-ticket, high-volume model. Dental cleanings, small medical co-pays, therapy sessions, and professional consultations are typically billed in smaller increments but occur frequently. While this structure works for patients and clients, it can have significant cost implications for providers when network fees are applied. One of the most impactful fees to understand in this context is the Fixed Acquirer Network Fee (FANF), charged by Visa and passed along through acquiring banks and processors.
For many healthcare and professional services providers, FANF comes as a surprise when they first notice it on their monthly statements. Because FANF is based not only on transaction volume but also on the type of business and whether transactions are card-present or card-not-present, low-ticket/high-volume businesses often end up in higher fee categories.
Understanding Low-Ticket/High-Volume Transaction Profiles
Low-ticket/high-volume businesses process many transactions each day, each with relatively small amounts. For example, a dental office may process dozens of co-payments of $20–$50 per day, while a counseling practice may handle multiple sessions billed at $75 each. Over time, this results in high transaction counts, even if the total dollar amount is not especially large. Payment networks categorize these businesses differently from high-ticket, low-volume industries like automotive or luxury retail because the risk and operational costs of managing so many transactions are higher.
From a FANF perspective, the emphasis is on the number of transactions processed monthly. Healthcare and professional services providers often find themselves in tiers where FANF is calculated against their transaction volume, leading to higher monthly fixed fees compared to businesses with fewer but larger transactions. This makes it essential for providers to understand how their billing model directly influences their FANF obligations and overall payment processing costs.
What is the Fixed Acquirer Network Fee (FANF)?
The Fixed Acquirer Network Fee is a monthly fee assessed by Visa to cover the cost of maintaining its network infrastructure. Unlike interchange fees, which are based on a percentage of each transaction, FANF is a fixed fee determined by business type, transaction method, and volume. Healthcare, dental, and professional service providers fall into categories where FANF is tied heavily to card-not-present transactions or high transaction counts.
FANF is passed down from Visa to acquiring banks and then to processors, which means it shows up as a non-negotiable line item on a provider’s monthly statement. The amounts can vary widely depending on the provider’s profile. A small dental practice might pay relatively modest FANF charges, while a larger healthcare system processing thousands of small co-payments each month could face much higher costs. Because FANF is not negotiable, providers need to focus on understanding how it is calculated and what strategies can be used to minimize its impact.
Healthcare and Dental Providers: Why They Are Affected
Healthcare and dental providers often have unique billing structures that drive up transaction counts. Many practices collect smaller amounts directly from patients at the time of service while larger claims are billed to insurance. This means that co-pays, out-of-pocket expenses, and partial payments contribute to high transaction volume on card networks. Even though each charge may be modest, the cumulative effect places these businesses in higher FANF brackets.
For dental practices, regular visits such as cleanings and checkups create steady streams of transactions. Similarly, healthcare clinics handling numerous patient visits daily accumulate hundreds of card payments over a short period. FANF does not scale with ticket size—it scales with transaction volume. As a result, even providers that generate modest overall revenue can find themselves paying disproportionately high FANF fees. Understanding this dynamic helps providers see why their fee structures look different compared to industries with larger, less frequent transactions.
Professional Services and FANF Implications
Professional services such as law firms, accounting offices, therapy practices, and consulting businesses also fall into FANF structures tied to transaction counts. While some professional services charge higher hourly rates, many process small retainers, installment payments, or recurring billing for ongoing work. For example, a therapy practice may bill weekly sessions in smaller amounts, while a law firm may break down invoices into multiple payments across a billing cycle.
These frequent transactions mean that professional services providers, much like healthcare and dental practices, are treated as high-volume processors even if individual payments are not large. For FANF purposes, what matters is how many times the card network is used, not how much money changes hands per transaction. This creates challenges for service-based businesses that rely on flexible billing models to accommodate client needs but end up paying more in fixed fees as a result.
Card-Present vs. Card-Not-Present Transactions
One of the most important factors in FANF calculation is whether transactions are card-present or card-not-present. Card-present transactions occur when a patient or client physically presents their card at the office or clinic. These are considered lower risk and may fall into lower FANF tiers. Card-not-present transactions include online payments, recurring billing, or phone payments, which are considered higher risk and often fall into higher FANF categories.
For healthcare and professional service providers, the shift toward digital payments and online bill pay means that more transactions are card-not-present. While this improves convenience for patients and clients, it also increases FANF obligations. Providers must balance the demand for easy payment methods with the reality of higher costs. Some practices encourage in-person payments where possible to lower FANF exposure, though this must be weighed against patient satisfaction and the growing trend of digital-first billing.
Strategies to Manage FANF Costs
Although FANF is non-negotiable, providers can use strategies to manage its impact. One approach is to streamline billing cycles. Instead of processing small, frequent payments, practices can consolidate charges into larger monthly or quarterly bills when appropriate. For subscription-style services such as membership-based dental care or therapy programs, offering clients the option to prepay for multiple sessions can reduce transaction counts and, in turn, FANF obligations.
Another strategy is to diversify payment methods. Encouraging patients and clients to use ACH transfers or digital wallets can reduce reliance on card transactions, thereby reducing the total volume that contributes to FANF tiers. Practices can also implement account updater services to reduce declines and reattempted charges, which add unnecessary volume without generating revenue. By carefully managing how and when payments are processed, providers can soften the financial impact of FANF while still maintaining flexibility for patients and clients.
The Role of Processors in FANF Transparency
One of the recurring issues with FANF is that many providers are unaware of it until they see it on their monthly statements. Payment processors often do not explain FANF clearly during onboarding, leaving healthcare and professional services businesses surprised by the fees. To avoid this, providers should proactively ask processors for detailed explanations of how FANF applies to their accounts. Transparent processors will be able to provide breakdowns of transaction volumes, tiers, and fee calculations.
Choosing a processor with a clear understanding of healthcare, dental, and professional service billing models can make a significant difference. Some acquirers specialize in these industries and may offer tools or reporting features that help practices manage transaction volume more effectively. While FANF itself cannot be waived, better communication and visibility from processors allow providers to budget accurately and explore ways to minimize the effect of high transaction counts.
How Growth Impacts FANF in Service Industries
As healthcare, dental, and professional service businesses grow, their FANF obligations typically increase. More patients, more appointments, and more recurring billing cycles all contribute to higher transaction volumes, pushing providers into higher fee brackets. For practices planning to expand, FANF should be included as a predictable cost in financial projections. Ignoring it can create margin pressure as transaction volume scales.
For example, a therapy practice doubling its client base may see FANF expenses rise even faster than overall revenue. Similarly, a growing dental group expanding into multiple locations will face increasing transaction counts that affect FANF. By factoring FANF into growth models, providers can ensure they set pricing structures that cover these unavoidable costs. Forward planning helps businesses avoid financial surprises and maintain healthy profitability as they scale.
The Future of FANF for Healthcare and Services
The healthcare and professional services industries are rapidly adopting digital-first payment solutions, from online bill pay to subscription-style memberships. As this trend continues, card-not-present transactions will likely increase, further affecting FANF exposure. At the same time, payment networks and regulators may revisit how fees are structured as digital payments become standard across industries. Future adjustments to FANF could refine how transaction volume is measured or offer new categories for service-based businesses.
In the meantime, healthcare, dental, and professional service providers must accept FANF as part of the cost of doing business. By staying informed, working with transparent processors, and adopting smart billing strategies, they can manage the impact effectively. FANF may be non-negotiable, but it does not have to be unmanageable. With proactive planning, providers can balance convenience for patients and clients with the realities of payment network fees.
Insurance Payments and Their Effect on FANF
In healthcare and dental practices, insurance reimbursement plays a significant role in payment processing, but its relationship with FANF is often overlooked. While many insurance payments arrive via checks or ACH transfers, patient responsibility portions such as co-pays, deductibles, or uncovered services are usually settled through card transactions. This creates a unique dynamic where providers may process relatively modest amounts via cards but in very high frequency. These smaller payments stack up and contribute directly to higher FANF tiers, even though the bulk of revenue might be arriving through non-card channels.
Professional service providers who accept partial payments while waiting for insurance reimbursements face similar challenges. For example, a physical therapy clinic might process numerous $30 or $40 transactions daily while larger reimbursements arrive later from insurers. While insurance-related funds bypass FANF, patient-side transactions ensure that FANF remains a recurring expense. Providers must carefully balance convenience for patients, who prefer card payments, with the financial reality of rising fixed network fees tied to transaction counts. Exploring blended strategies that include ACH, digital wallets, and patient portals can help reduce card dependence while still offering flexibility.
The Patient and Client Experience with Payments
From a patient or client perspective, paying via card is often the easiest and most trusted option. Healthcare and professional services providers know that offering smooth card payment options supports satisfaction, loyalty, and faster collections. However, this convenience translates into higher FANF costs for providers due to the low-ticket, high-volume profile. Eliminating card payments altogether is not a realistic solution, as it could frustrate patients and increase unpaid balances. Instead, the challenge becomes how to provide payment flexibility without letting fees spiral out of control.
Modern patient portals and payment systems can help by encouraging alternative methods such as direct bank transfers, while still making card use available. Transparency in billing also plays a role, as clear statements and digital reminders reduce declined or disputed payments that contribute to excess transaction attempts. Providers must strike a balance between financial efficiency and patient trust. Maintaining convenience is essential, but guiding patients toward efficient payment options can soften FANF’s impact while preserving the overall experience.
Comparing Small Practices to Larger Healthcare Systems
The impact of FANF looks very different depending on the size of the provider. Small dental offices or local counseling practices may process dozens of small card payments each week, leading to modest but noticeable FANF expenses. For them, these fees can feel disproportionate because margins are already tight and revenue streams are limited. In contrast, larger healthcare systems processing thousands of small payments each day often face very high FANF obligations, but these are spread across much higher total revenues. The relative impact on profitability depends heavily on scale.
Larger systems also tend to have more leverage with processors, giving them access to advanced reporting tools and streamlined reconciliation systems that help manage overall costs. Smaller providers rarely have this advantage, which makes education and proactive strategy even more important. Regardless of size, every healthcare or professional service provider must account for FANF in their financial planning. For smaller practices, even modest changes to billing strategies can make meaningful differences, while larger systems must focus on scalability and efficiency as transaction counts continue to grow.
Future Trends in Service-Based Payment Models
The payment landscape in healthcare, dental, and professional services is evolving quickly. Patients and clients increasingly expect digital-first options, from online bill pay to mobile wallets. Subscription-style membership models are also gaining popularity, such as dental care plans or therapy packages billed monthly. While these innovations improve accessibility and engagement, they also raise FANF implications by shifting more payments into card-not-present categories. As digital adoption increases, providers may find themselves in higher fee brackets even if their total revenue remains steady.
Looking ahead, providers must monitor how FANF rules adapt to these trends. Payment networks may refine categories or create new structures as recurring billing becomes more common in service industries. At the same time, alternative payment technologies such as real-time payments and open banking could reduce reliance on cards, lowering FANF exposure in the long term. For now, providers should assume FANF will remain a significant fixed cost, but staying ahead of industry changes can help them pivot quickly as new solutions become available. This adaptability will be key to balancing cost control with patient-centered convenience.
Conclusion
For healthcare, dental, and professional service providers, the low-ticket/high-volume model creates unique FANF challenges. Even though each transaction is relatively small, the sheer volume of charges places these businesses in higher fee tiers. Understanding how FANF is calculated, the role of card-present versus card-not-present transactions, and the impact of recurring billing helps providers see why their costs are structured the way they are.
While FANF cannot be avoided, it can be managed. By consolidating billing, diversifying payment methods, and working with transparent processors, providers can reduce unnecessary expenses and plan more effectively. Growth will always bring higher transaction volumes, but when FANF is factored into financial planning, it becomes a predictable cost rather than a disruptive surprise. In 2025, service-based businesses that approach FANF with knowledge and strategy will be better positioned to thrive, balancing financial health with the patient and client satisfaction that remains at the core of their work.