Talk about the money!

by Cathy Jameson, PhD

Don't avoid talking to your patients about the cost of treatment! Let them know you have payment options to fit their needs.

Do you ever hear any of the following questions or statements about the cost of treatment from your patients?

"That much for one tooth?"
"I knew it would be a lot, but I had no idea it would be this much!"
"Does my insurance cover this? If it doesn't, then I don't think I can get this done."
"Can we just do a little bit of this now and a little bit later? Can we spread this out over time so that I can fit this into my budget?"

These are not unusual statements or questions. In fact, we could fill up this article with questions and comments from patients concerning the financing of their dentistry. In a November 2001 article for Dental Economics, I outlined several financial options that will let your patients comfortably finance the treatment you have recommended, while keeping you out of the banking business.

However, establishing a financial policy and offering great payment options is only a part of the "system." Knowing how to present these options and being comfortable addressing very normal objections are essential if you are going to be successful in offering these options. Communicating with your patients about their financial responsibility and about the options you have available for payment may be one of the most challenging conversations you will have with a patient.

Even if the doctor or treatment coordinator gets the "go ahead" from the patient, don't be too confident. The closing on the clinical aspects of the treatment is the "preclose." The final close comes when the patient agrees to the financial responsibility and schedules that first appointment.

In this article, you will learn three aspects of communicating financially:

How to present the fee
How to present the various options
How to overcome objections - particularly about the patient financing programs

Presenting the fee

Exceptions exist to every "system," and you must know when to "flex" with each one. However, if you make flexing the norm, you no longer have a system. So, in most cases, I recommend that you present your fee in the following manner:

Answer all clinical questions before you discuss the fee or the payment options. Quoting a fee too early can be worse than not quoting a fee at all. So, make sure that you answer all questions related to the clinical aspects of treatment.

Establish an environment where patients feel comfortable telling you about their financial concerns. You want people to tell you about their problems so that you can discuss them. Then - and only then - can you do something about those problems.

Keep the money questions where they belong. Do not discuss money before patients have "bought into" the treatment. Make sure that they are focused on the clinical discussion when you are talking about treatment. If your patients are thinking about money while you are discussing treatment, they won't hear a thing. The human mind can only think about one thing at a time. So, if they are thinking about money, they aren't hearing a word you are saying! For example:

Dr.: "Mr. Patient, before I give you the results of my analysis - and before I explain the treatment that I am going to recommend for you - let me emphasize that if you have any concerns about the financing of your treatment, we do have convenient, long-term financing right here in our practice. I tell you this so that, for now, we can both concentrate on the treatment I am recommending.

"We will discuss your financial options in full. We want to make sure that you are clear and comfortable with this important part of your treatment. But for now, I would like for us to focus on the treatment I am going to recommend, the treatment that I believe would help you reach your goals. Is that OK with you?"

After you have made your presentation of recommendations and have answered any questions about the treatment itself, ask this question if the patient expresses a concern about the cost:

Dr.: "Is financing the cost of your treatment a concern for you?"

Patient: "Yes. I'm sure this will cost quite a bit."

Dr:. "I can appreciate your concern. That's why Jan, my financial coordinator, is joining us today. She will discuss the total fee and the options we have available for payment. We have some great options, and I'm sure she will be able to work this out with you.

"Let me ask you this. Once you and Jan work out the financial aspect of treatment, is this the type of treatment you would like to receive?"

Once the doctor has presented the treatment plan and answered questions, the financial coordinator takes over. She approaches the financial discussion in the following manner:

Financial coordinator: "Mrs. Jones, I know that the doctor asked if you had any questions and you said "no." But I thought there might be something that you would like to ask me about the clinical aspects of treatment." Answer those questions - if there are any. Talk about the benefits of the recommended treatment. Get a closure on the treatment itself ... and then quote the fee.

Financial coordinator: "Mrs. Jones, the fee for the treatment the doctor is recommending is $3,000. How would you like to take care of that?"

Ask this question and then listen very carefully for the direction the patient will take regarding his or her financial needs. Present each patient with a financial option that you believe would work best for that individual. The financial coordinator's job is to find a financial solution for each patient. Now let's discuss how to present the various financial options that are available to the patient.

Five percent accounting reduction

Financial coordinator: "Mrs. Jones, many of our patients have chosen to have their fee reduced. Would that be of interest to you?"

Mrs. Jones: "Of course!"

Financial coordinator: "If you pay for your treatment before the doctor begins, we will reduce your fee by 5 percent. If we are not involved with the bookkeeping, that saves us both time and money and we like to pass those savings on to you. Would that work for you?"

Payment at the end of each appointment

Financial coordinator: "We ask for 1/3 of the cost of treatment to reserve the appointment with the doctor, 1/3 when the doctor actually prepares the teeth for the veneers, and the final 1/3 when the veneers are placed into position."

Another way of saying this is:

Financial coordinator: "We ask for $ to reserve the appointment time with the doctor, $when the doctor prepares your teeth for the veneers, and the final $ when the doctor places the veneers."

A third way of approaching this would be to say:

Financial coordinator: "Mrs. Jones, the fee for the treatment is $1,200. The doctor will be seeing you for three visits, so we will spread the payments equally over the three appointments. That means your financial responsibility will be $400 per appointment."

Credit cards

If you allow patients to charge their treatment to credit cards, you might discuss payment this way:

Financial coordinator: "We do accept all major credit cards. When you finance your dental care with a credit card, you can spread the payments over time and make payments that fit your individual situation. In addition, many of these cards offer you frequent flyer miles for the amounts that you charge. Many of our patients like to take advantage of this opportunity."

Patient financing programs

Patient: "I want to get this done, but I need to spread out the payments and I don't want to use my credit cards."

Financial coordinator: "Mrs. Jones, we have a financial partner who helps our patients finance their dental care in exactly the way you have described."

Patient: "Oh, I just want to pay this out with Dr. Smith. I've been paying Dr. Smith this way forever. Why can't I just keep on paying him the way I always have?"

Financial coordinator: "I can appreciate what you are saying. However, we have changed accounting methods and are no longer able to carry long-term accounts on our own books. We found that it wasn't time- or cost-effective for us. Now we are associated with a super company, (name of company), that works with us to offer convenient financing for our patients.

"We're committed to maintaining reasonable fees for our services. So, we searched for a better, more cost-efficient way to offer long-term financing to patients. (Company name) has become an important part of our dental team. We have always been committed to providing you with comfortable dentistry, and now we can extend that comfort into the area of financing as well."

Patient: "Tell me more about this company. I don't understand this."

Financial coordinator: "(Company name) is a financing company for dentistry. Through their program, you can conveniently budget your treatment into your monthly income."

Patient: "I don't know about this. Is this a difficult thing to do?"

Financial coordinator: "Not at all! The application is very easy. In fact, you can apply right here in our office. The application will be similar to any application you have filled out previously, but if you do have any questions, I'd be glad to answer them. We can send your application over the Internet, and will know almost immediately if the company will be able to extend a line of credit to you. Then, we can go ahead and schedule your first appointment. I know you are anxious to begin treatment. That beautiful smile can be yours."

Patient: "Will they charge me interest?"

What follows are two responses to this question - one to describe a revolving payment plan and one to describe an interest-free plan)

Revolving payment plan

Financial coordinator: "Yes, just like other financing programs, a service fee is involved. This fee is 1.75 percent or approximately $1.75 per month for every $100 that you finance. That's not much considering the fact that you can now have those veneers that you have wanted for so long and the monthly investment will fit your budget situation." (Use the figures and percentages appropriate to your program.)

Interest-free plan

Financial coordinator: "Believe it or not, Mrs. Jones, we do have a plan where there is no interest charged. Our financial partner offers a three-, six-, or 12-month interest-free program. You will need to make a minimum payment per month, which is three percent of the outstanding balance. But, if you pay off the entire amount within the time frame you select, there will be no interest charged at all. If for any reason you cannot pay this off in the selected time frame, you have a safety net. Your account will convert to a revolving payment plan and you can continue to make a minimum payment per month. However, I do want you to know that if you cannot pay the full amount in the designated time frame, you will be charged all back interest. So, it is important that we work together to find a time frame that fits your situation.

Patient: "I don't know about this! I just wish I could pay Dr. Smith the way I used to!"

Financial coordinator: "I know how you feel. We have had other good, long-term patients who have felt the same way until they found out they could still pay out their dentistry. In fact, their monthly payments are usually smaller, and they can take longer to pay their account in full. We have many families utilizing the (company name) plan."

They love the convenience! These families seem happier not owing the doctor, and, because of their available credit line, they can take better care of their entire families."

Extended payment plan

Financial coordinator: "Mrs. Jones, we can spread your payments out over a period of time to keep your monthly payments small and convenient. Our financial partner offers an extended payment plan, which is very much like a car loan. Depending on how much you can pay per month, we will determine whether you need to extend your payments over a 24-, 36-, 48-, or 60-month period. Tell me, Mrs. Jones, how much per month would be comfortable for you?"

Patient: "I guess about $200 per month."

Financial coordinator: "Great! Let's look at this payment schedule from our financial partner. Based on what you have told me, you can maintain that type of a payment schedule by accessing an extended payment plan of months. (These types of schedules are available from the various companies). And, if you are half way through your payment schedule and want to pay off the entire amount, you can do so without a penalty."

Communication is the bottom line to your practice's success in anything that you do and in any interaction you have with a patient. Certainly, when you are in a financial discussion with a patient, you are having an intimate and personal conversation. Handling this discussion with professionalism, care, and understanding will impact your long-term relationship with your patients and will influence whether or not they proceed with treatment.

Spend some time studying the verbal and communicative skills I have recommended in this article. Practice these skills. Get comfortable with them so that whether you are presenting a fee, a financial option, or handling an objection, you will be able to deal with these various conversations with confidence.

How you say something can make or break the entire situation. Practice! The more you practice, the more comfortable you will become. Your comfort will impact your patient's comfort. Your patients will win ... and your practice will win!

Remember: Great communication equals great production!