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Talking fees with your dental patients: Why it's your job (or should be)

Oct. 3, 2022
When it comes to dentists discussing fees with their patients, many people are of the opinion that dentists should "stay in their lane" and not go there. Here's why Sharyn Weiss soundly disagrees.

How do you feel about discussing fees with your patients? This was a question posed recently in a dental Facebook group. Many folks answered that dentists should stay in their lane and not talk about fees at all. They asserted that dentists specialize in clinical care and don’t have the skill set to talk about prices, or it's just not their job to do so.

Hmmm ... I disagree with this perspective. I’ll use a nondental-related analogy to explain why.

Let’s pretend you go into Best Buy to get a new computer. You wander the aisles and see dozens of computers on display. None of the computers have price tags. A clerk comes over to help you, and you describe what you need. The clerk points to a model and tells you this model will work for you.

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Then you ask, “How much will it cost?” The clerk says, “Well, I’m the expert on what our computers do; I don’t know our prices. You need to go to the cashier to find out how much it is and our payment options.”

You glance over at the cashier desk and see a number of people waiting impatiently in line, while the cashier is also answering phones.

If you were the customer, you’d find this maddening. But isn’t this pretty much what you do if you tell patients they will need to “go up front” to talk fees?

Here are some consequences of not talking about fees with patients:

  1. Shunting your patient off to the front desk means that your employees are “closing” your patients, and you’re out of the loop with responding to your patient’s concerns. If a patient balks at doing a large treatment plan, then your front desk team and the patient are making decisions about what to cut out. Often, this means that your front desk employee has to chase you down to learn what can be cut from a treatment plan to accommodate the patient’s financial concern. This is both awkward and time consuming.
  1. Unless you have a dedicated treatment coordinator who uses a consult room, your front desk team are pulled in multiple directions and may not have sufficient time or training to work with a patient who has questions and concerns. And it is not appropriate to discuss sensitive issues like finances in a reception area where other patients can overhear, or the phones are ringing.
  1. In addition, your front desk employees may not have the skill set to work with patients on an emotional level. Reviewing a patient’s benefits is not the same skill as connecting a patient’s motivators to recommended treatment.
  1. Finally, the biggest reason why it’s a bad idea not to discuss fees is that for most patients, their objection to fees is not due to a lack of money but due to the value they place on the treatment itself.

What do financial objections really mean?

Dentists may assume that financial discussions are simply a matter of sharing the fee and then working out a payment arrangement. If a patient balks at the fee, then the financial coordinator simply needs to adjust the payment schedule. If you believe this, then I can see why you don’t think it’s necessary to discuss fees with your patients.

But for most of your patients, it’s not about the money or the payment arrangement. You can offer Care Credit until the cows come home, but that isn’t going to address the real issue. The real issue is that patients don't perceive the value for treatment as compared to their investment.

Let me rephrase this. When you talk about fees with patients, you are not actually talking about money. You are talking about the value of the treatment. When patients perceive the value of treatment, then money concerns frequently dissipate.

Benefits of discussing fees

Let’s address your discomfort by describing what I mean by discussing financials with patients. I wrote about how to have treatment dialogues with patients in a previous article. (Find it at dentaleconomics.com/losethelectures.) A treatment dialogue contrasts with traditional treatment presentations because the focus is on:

  • Increasing the patient’s intrinsic motivation for treatment by having them name the benefits they most value.
  • Reaffirming the patient’s autonomy to choose.
  • Providing a fee range so the patient can make an informed decision.

What it sounds like

After you describe your treatment recommendations, ask this series of questions:

  • I see a great benefit in taking care of this now, but how do you feel about this? What do you see as the most important reason to have this treatment?
  • What would change in your life once you complete this treatment?
  • The fee for this ranges from X to Y. How does this match what you were expecting?
  • Given everything we’ve talked about, what thoughts do you have about your next best step?

That doesn’t sound too hard, does it? The beauty of these questions is that they invite the patient to reflect on the benefits of treatment in context with the financial investment. I won’t balk at a $5,000 fee if I value and want the results that investment will bring to me.

But if the patient does wince at hearing the fee, then you are in an ideal spot to investigate further and learn more about what the patient would value. This conversation has to be with you and not an employee. Your job is to learn what the patient the patient really wants, and then connect that to their clinical needs.

“I notice that you seem uncomfortable about the fee. How are you feeling about what we’ve just talked about? What would help you feel more comfortable?”

Note something important here. You are not asking the patient to list concerns or objections that could result in them feeling even less motivated. You are asking what they need from you so they feel more comfortable in moving forward. These questions steer the patient toward removing their own barriers by focusing their attention on solving this issue.

I believe that dentists should view conversations about fees as an essential and seamless part of their conversations about treatment. This conversation isn’t about making financial arrangements but about perception of value. This can be a great opportunity to cement your relationship with your patients and increase their commitment to oral health.

Editor's note: This article appeared in the October 2022 print edition of Dental Economics magazine. Dentists in North America are eligible for a complimentary print subscription. Sign up here.

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