Part 1: Helping Patients Pay for Treatment.
When a patient accepts the treatment that a doctor has recommended, it’s an exciting time! It’s exciting for the patient because he or she has caught the vision of improved dental health. It’s exciting for the dentist because he or she has effectively communicated to the patient the importance of treatment. Soon, the dentist will be able to help the patient improve their dental aesthetics and/or function.
Sometimes, patients and dental teams get caught up in the excitement of accepting treatment without realizing that the next step of finding the money is often challenging. Most dentists will tell you that it’s rare to find a patient who accepts large cases and has unlimited financial resources to pay for it.
Why is finding the money the responsibility of the dental team? Isn’t it the patient’s responsibility? Of course, it’s the patient’s responsibility to pay for treatment. However, patients are not always aware of the many financial options that may be available to help.
Don’t put your practice in the position of becoming the bank for the patient. Your practice should not take the financial risk if a patient can’t come up with money for dental treatment. Instead, train your team members to help patients find ways to pay for treatment.
Things Do Happen
Unexpected events are a part of everyday life. Sometimes it’s a car that requires money for repairs. Sometimes a roof starts leaking and needs fixing. Sometimes it’s the opportunity for a trip with a dear friend. Whatever the reason, things happen and when they do, patients either scale back on the treatment or they cancel altogether.
Years ago, when I was working for a dental office in Arkansas, we discovered that we could be proactive and help patients find money for treatment—even if they didn’t think they could. And guess what happened after patients found the money? They didn’t cancel their appointments!
Recently, I spoke with a financial coordinator in a dental office who told me that the doctor she works for had a big case that went off the schedule at the last minute. The first thing I asked was, “How was the patient paying for it?” If the patient was bringing in cash on the day of the appointment, he or she probably got buyer’s remorse and changed their mind, or had a life’s unexpected event happen.
When that happens, the office will have up to three or four hours in a doctor’s schedule to try and fill at the last minute.
Instead of waiting until the day of treatment for payment, make all financial arrangements (whether cash or other methods) in advance of scheduling treatment. Always find the money first and then schedule patients for treatment. That way, dental teams can count on patients showing up. Finding the money in advance of treatment is one of the best ways to stop “no-shows” in the schedule.
In the practice where I worked, after a patient had been diagnosed I would say, “I can tell you’re so excited. If you’d like, we can take care of this today and then we can get all your appointments scheduled.” I made this comment to everyone because I learned never to judge a patient’s pocketbook.
Cash payments are great but if financial coordinators wait to collect payment until the day of treatment, any number of unexpected life events can happen between the time a patient agrees to treatment and the day he or she shows up for the appointment.
Some dental practices ask about paying half down and half at completion. I don’t recommend this strategy because things happen and when it comes time for completion, patients sometimes don’t have the rest of the money. By that time, the practice has already incurred expenses such as salaries, supplies, utilities, and lab bills. That’s one reason it’s better to find the money before scheduling treatment.
Assess the Situation
How do you know if your patients need help finding the money? The subject usually comes up after quoting the fee to the patient. Once a dentist outlines the clinical plan, it’s best if he or she can quote the fee to the patient.
Dr. Dick Barnes always says, “Be firm in principle, flexible in procedure.” Someone does have to quote the fee, but there’s flexibility in who quotes it—whether it’s the dentist or the financial coordinator.
Whoever quotes the fee should wait three seconds afterwards to let the patient absorb the information. Then, if he or she doesn’t respond, the financial coordinator can follow up with the following scenario:
Financial Coordinator: “Did that surprise you?”
Financial Coordinator: “Help me understand . . . is it the treatment?”
Patient: “No, it’s the money.”
Financial Coordinator: “So that I understand you correctly, this is the treatment that you’d like to have if we can fit it into your budget. It is, isn’t it?”
With the confirmation of a desire for treatment and a concern for finances, the financial coordinator can start to help the patient find the money.
The next part of the conversation goes something like this:
Financial Coordinator: “Some companies that we work with offer no sign-up fees, no annual fees, interest-free money, and you pay no money down. You get to keep your cash. It has worked well for a lot of our patients. Perhaps this is something that you’d like too?”
Patient: “That sounds great.”
Financial Coordinator: “Will you share with me what fits into your budget?” (the financial coordinator is trying to assess whatever monthly payment the patient can afford.)
Patient: “I think I can do two hundred dollars per month.”
Financial Coordinator: “If you can afford two hundred, do you think you could stretch to two hundred and fifty dollars per month?”
Patient: “I think that would be okay.”
Financial Coordinator: “Two great companies we use are CareCredit and Lending Club [healthcare financing organizations]. When using them, you get to keep your cash. You pay it out over time. In fact, you would not have to pay any money down and you would assume monthly payments.”
At this point, I always brought out a repayment schedule from the lending company, and then I could see how much treatment patients could get. For example, if they paid $250 per month on interest-free money for a year, they could get $3,000 worth of treatment. If they financed payments for 36 months, it would no longer be interest-free, but they could get up to $7,500 worth of treatment for that same $250 per month payment.
If patients financed for 60 months, the payment would drop to $166 a month and they could get up to $10,000 worth of treatment. Furthermore, there’s no pre-payment penalty for paying off the loan early.
After checking the repayment schedule and offering different scenarios to the patient, the financial coordinator then says:
Financial Coordinator: “If you’ve got just a few minutes, we’ll get this taken care of and then we will get you scheduled.”
Make It Easy
Here’s another secret to finding the money: do it while the patient is still in your office. Don’t simply send patients home with a brochure about CareCredit, LendingClub, or any other financing options or they probably won’t follow through. If financial coordinators help patients submit their applications for financing—whichever financing option they choose—it takes just a few minutes and then you can get them scheduled.
Years ago, CareCredit called and asked me what we were doing because our practice had a high patient approval rate. In fact, our practice was in the top 5 percent of approval ratings of any office in the United States. After I explained our process, they learned that there were two primary reasons for our success. First, we presented financing to the patients while they were in the office and helped them with the process.
Second, I developed relationships with patients, so they felt comfortable sharing their financial information with me. If for any reason a patient would probably not get approved for financing, he or she would tell me about it before I submitted their name for approval. I did not submit names for financing if the patient disclosed that he or she had poor credit. Hence, our approval rate went way up.
Sometimes financial coordinators hesitate to proceed with this financing option because they think their patients will not get approved. They use this as a last resort instead of a first resort. Financial coordinators should never judge a patient based on their finances. Instead, it’s important to offer alternatives that may work for patients in such circumstances.
When patients share their concerns about obtaining financing, here’s a scenario that I suggest:
Patient: “Healthcare financing is probably not going to work for me. I don’t have a good credit score.”
Financial Coordinator: “Thank you for sharing that and for being honest with me. You obviously have a good reason. But still, is this the treatment you would like to have if we can find a way? It is, isn’t it? So, let’s do this. Would there possibly be anybody who could help you? Is there anyone who could co-sign with you?”
Patient: “Well I think my father-in-law might help.”
Financial Coordinator: “Would you like me to call him? If you’d like we could call right now.”
Patient: “Oh gosh, would you call him?”
Financial Coordinator: “Of course!”
One time, a young lady came into our dental practice and needed a root canal, a crown, and some other dental work. The dentist told me, “Tawana, this girl doesn’t have any money. She doesn’t even have a car. But it’s important to get for her to get this dental treatment done and I want you to see if you can help find some money for her.”
After I presented the financing options, the young woman said, “I don’t have good credit.” I asked her what amount of money fit into her budget and she responded, “fifty dollars.” And just like in the previous scenario I said, “Is there anyone who can help you?” She replied, “My boyfriend’s mother has offered to help me finance a car. She might be able to help. Would you call her?” I did, and the woman agreed.
Soon afterwards, the woman came by the practice with the money for treatment. She couldn’t afford both the car and the dental treatment, so the young woman made the decision to get her teeth done. She realized the importance of keeping her teeth and chose her teeth over a car, even though it meant she had to walk everywhere in the cold and snow where she lived. Eventually, the young woman married her boyfriend and became part of the woman’s family.
Success with finding the money is much higher if financial coordinators can obtain financing while the patient is in the practice. However, patients occasionally go to their own credit union or another resource to obtain money for treatment.
When a patient leaves the practice to find other financing resources, it’s important to stress the urgency of the treatment for the patient. The following scenario is often useful:
Financial Coordinator: “So may I presume that you’re excited about this recommended treatment [aesthetic]?” Or, “Do you see the urgency in getting treatment done [functional]?”
Patient: “Yes, I understand.”
Financial Coordinator: “Could I presume that you’re going to pursue those resources tomorrow?
Financial Coordinator: If so, what is a good time tomorrow afternoon for me to call you?”
Sometimes, patients will say that they have to discuss it with a spouse or significant other before they make a decision. When that happens, the financial coordinator’s next question would be:
Financial Coordinator: “Is it the treatment?”
Patient: “No, it’s the money.”
Financial Coordinator: “Could I presume that you’re so excited, you’re going to discuss this tonight? If so, what would be a good time tomorrow for me to call you?”
After each conversation, I literally made an appointment card and called the patient at the appointed time. Never, never tell patients, “Oh just get back to me when you can.” I was proactive because I understood the recommended treatment for the patient. I knew it was either was something that he or she really wanted, or it was something important because he or she was in pain. Either way, getting treatment done was a priority.
Time is Money
Another time, a patient in our practice was given a diagnosis for four crowns. The patient said to me, “I know the doctor recommended four crowns, but I can only afford to do one right now.”
It’s important never to argue with patients. So instead of arguing, I just looked puzzled and said, “Okay.” Then I continued with, “I know that your time off work is important to you and a big consideration. If we single out the work, it’s going to take eight appointments to prep and seat each crown. However, if we could find a way to get everything done at the same time, you would only have two appointments.”
The patient said to me, “Yes, but I don’t have that money.” And I responded, “Well, let’s see if we can find a way.” And then I went through the scenarios to see if we could find some money for him to do all of the treatments together.
By doing multiple crowns at once, I have seen practices double and sometimes triple their per-hour production. Combining treatments together saves chairside time for practices and patients.
Always Have Hope
Occasionally, despite everyone’s best efforts, it’s sometimes impossible to find money for treatment. The patient can’t get money or financing on their own or through healthcare financing, and they don’t have a friend or relative who can help them. It’s agony!
In those circumstances, I would look at the patient with endearment and say,
Financial Coordinator: “You know Bob, none of these financing options so far have worked out for you. One last time, I want to ask you this question for my own understanding—if we could have worked this out, this is still the treatment you’d like to have. It is, isn’t?”
Patient: “Yes it is, but as you see, right now I’m having everything in the world happening to me, and I cannot do anything.”
Financial Coordinator: “Well Bob, please be patient with us. We will get there.”
And then I would say, “It’s kind of like going from Fort Smith, Arkansas to New York City. Sometimes we go on a jet airplane, and we get there quickly, and sometimes we go in an automobile and it takes a lot longer. Ultimately, however, we will get there.”
Then you have to start giving the patient hope. Tell the patient the following:
Financial Coordinator: “We’re going to keep you in our recall schedule because we want to make sure you come here every six months.” In other words, don’t make any patient feel like they don’t belong in your dental practice because they don’t have the money at the time. And close with the following:
Financial Coordinator: “Because Bob, you never know when your circumstances are going to change!”
Financial coordinators must always give patients HOPE and make them feel welcome in the practice, regardless of present circumstances.
That last phrase is so important because it gives patients HOPE. And it’s the truth—you never know when a patient’s circumstances may change. I’ve watched people leave the practice, get second jobs, and return to the dental practice with the money several months later.
One woman walked into our dental practice, asked for me and said, “Tawana, I’ve brought you $3,000 today. I got a second job at an upscale restaurant and I’ve saved all this tip money.” Not only that, her husband detailed cars at night and on the weekends. Together they accumulated the $3,000 for treatment.
I’ve also watched patients’ circumstances change when they inherited money, postponed vacations, or sold personal items. I’ve seen all sorts of things happen. They did those things because there was value created for the dentistry.
I’ve witnessed patients get treatment after finding the money even though circumstances seemed dire. And I’ve watched dentistry change lives.
One young man came to our practice who had made poor choices in his young life. He needed a full mouth reconstruction. He was just a teenager. We tried everything to find money for his treatment and nothing worked out. I called his mother every couple of days as she tried to find financing options. He wanted desperately to smile in his senior pictures.
Eventually, his parents made the choice to re-finance their house in order to get the money for his treatment. It was an extreme situation. I’d never recommend this option as a first choice for finding the money—in fact it’s the very last thing I’d ever recommend. But the family placed a high value on getting this young man’s teeth fixed.
Dr. Dick Barnes always taught that Value = Benefits greater than the cost. For this young man, the value and benefits of getting treatment greatly outweighed the cost. Today, years after getting his treatment done, this young man who never had a girlfriend or the confidence to interview for a job, is married and has a productive career.
Recently, I ran into a woman who had been to our dental practice years ago. She heard me talking and said, “I know that voice. Tawana, I can’t believe it’s you! You helped me out more than 15 years ago. I will never forget how much you helped me.”
Finding the money is important because it helps patients get treatment that truly can change their lives. It’s thrilling to know that years later, patients are still grateful for such assistance. When financial coordinators help patients, it in turn helps the dental practice, and it’s gratifying for everyone. I hope you’ll help all your patients find all the options that are available for them. Start today.